Provider Demographics
NPI:1922141670
Name:MIRE, GLORIA E (LMFT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:E
Last Name:MIRE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2021 S WAVERLY AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2414
Mailing Address - Country:US
Mailing Address - Phone:417-889-6764
Mailing Address - Fax:417-889-6627
Practice Address - Street 1:2021 S WAVERLY AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2414
Practice Address - Country:US
Practice Address - Phone:417-889-6764
Practice Address - Fax:417-889-6627
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO300047101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health