Provider Demographics
NPI:1235617374
Name:GORE, AIMEE LARA
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LARA
Last Name:GORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14120 SW BARROWS RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5744
Mailing Address - Country:US
Mailing Address - Phone:352-398-9489
Mailing Address - Fax:
Practice Address - Street 1:14120 SW BARROWS RD UNIT 3
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5744
Practice Address - Country:US
Practice Address - Phone:352-398-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst