Provider Demographics
NPI:1598004293
Name:GILMORE, DEBRA ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DEBI
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:705 MONT CLAIR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-3382
Mailing Address - Country:US
Mailing Address - Phone:801-809-4770
Mailing Address - Fax:
Practice Address - Street 1:705 MONT CLAIR DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-3382
Practice Address - Country:US
Practice Address - Phone:801-809-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8520440-3904106H00000X
UT8520440-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist