Provider Demographics
NPI:1801385232
Name:GILLMORE, RACHEL ARLENE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ARLENE
Last Name:GILLMORE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 W HOUGHTON LAKE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-9388
Mailing Address - Country:US
Mailing Address - Phone:231-886-8295
Mailing Address - Fax:
Practice Address - Street 1:1821 W HOUGHTON LAKE DR STE C
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-9388
Practice Address - Country:US
Practice Address - Phone:231-886-8295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional