Provider Demographics
NPI:1467102376
Name:GILMORE, BRAD (LMFT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:GILMORE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 W OLYMPIC BLVD STE 1255W
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-5093
Mailing Address - Country:US
Mailing Address - Phone:323-201-7450
Mailing Address - Fax:
Practice Address - Street 1:11845 W OLYMPIC BLVD STE 1255W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-5093
Practice Address - Country:US
Practice Address - Phone:323-201-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131885106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist