Provider Demographics
NPI:1790186377
Name:GILMORE, DESMOND (LMHC)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:GILMORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:DESMOND
Other - Middle Name:
Other - Last Name:GILMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:31 W 20TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-6155
Mailing Address - Country:US
Mailing Address - Phone:561-899-9140
Mailing Address - Fax:561-331-2715
Practice Address - Street 1:31 W 20TH ST STE 200
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-6155
Practice Address - Country:US
Practice Address - Phone:561-899-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health