Healthcare Provider Details

I. General information

NPI: 1659155042
Provider Name (Legal Business Name): ELIJAH W GILMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 DETROIT AVE APT 410
CLEVELAND OH
44102-1871
US

IV. Provider business mailing address

9520 DETROIT AVE APT 410
CLEVELAND OH
44102-1871
US

V. Phone/Fax

Practice location:
  • Phone: 216-323-5914
  • Fax:
Mailing address:
  • Phone: 216-323-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: