Provider Demographics
NPI:1114134137
Name:GILMORE, TERESA HOLT (MSW, LISW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:HOLT
Last Name:GILMORE
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-5402
Mailing Address - Country:US
Mailing Address - Phone:740-383-3345
Mailing Address - Fax:
Practice Address - Street 1:264 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-3933
Practice Address - Country:US
Practice Address - Phone:740-387-2027
Practice Address - Fax:740-382-8022
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00089441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical