Provider Demographics
NPI:1689940223
Name:GILMORE, CYNTHIA MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:MARIE
Last Name:GILMORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 E 136TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-8744
Mailing Address - Country:US
Mailing Address - Phone:720-350-8694
Mailing Address - Fax:
Practice Address - Street 1:710 BURBANK ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1658
Practice Address - Country:US
Practice Address - Phone:720-350-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health