Healthcare Provider Details

I. General information

NPI: 1023552833
Provider Name (Legal Business Name): BRITTANY GILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MORGAN

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 EMPIRE ST STE 1500
FAIRFIELD CA
94533-5711
US

IV. Provider business mailing address

1234 EMPIRE ST STE 1500
FAIRFIELD CA
94533-5711
US

V. Phone/Fax

Practice location:
  • Phone: 707-426-4746
  • Fax: 707-419-4952
Mailing address:
  • Phone: 707-426-4746
  • Fax: 707-419-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberRBT-15-11530
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108854
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number131293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: