Provider Demographics
NPI:1720129794
Name:GORE, LAURENCE ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ROBERT
Last Name:GORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 HENDERSON RD
Mailing Address - Street 2:STE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-7300
Mailing Address - Country:US
Mailing Address - Phone:310-448-9510
Mailing Address - Fax:310-553-2003
Practice Address - Street 1:455 N. SHAWNEE LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-4145
Practice Address - Country:US
Practice Address - Phone:740-779-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.7116103TC0700X
CAPSY17037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical