Provider Demographics
NPI:1417410622
Name:GORE, CAITLYN ELIZABETH
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ELIZABETH
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 1:3231 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9417
Mailing Address - Country:US
Mailing Address - Phone:734-652-8120
Mailing Address - Fax:
Practice Address - Street 1:5726 SOUTHWYCK BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1559
Practice Address - Country:US
Practice Address - Phone:419-708-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional