Provider Demographics
NPI:1235363383
Name:GILMER, GARRETT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:L
Last Name:GILMER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LOUISIANA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1470
Mailing Address - Country:US
Mailing Address - Phone:419-490-5560
Mailing Address - Fax:
Practice Address - Street 1:330 LOUISIANA AVE STE A
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1470
Practice Address - Country:US
Practice Address - Phone:419-490-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6440103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling