Healthcare Provider Details

I. General information

NPI: 1659576122
Provider Name (Legal Business Name): RUSTY EUGENE GILMORE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RUSSELL GILMORE PH.D.

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 MANGROVE AVE STE 277
CHICO CA
95926-3948
US

IV. Provider business mailing address

702 MANGROVE AVE STE 277
CHICO CA
95926-3948
US

V. Phone/Fax

Practice location:
  • Phone: 530-514-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: