Healthcare Provider Details

I. General information

NPI: 1629689237
Provider Name (Legal Business Name): KELLY S GILMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY S MOSER LPC

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LOOP 281
LONGVIEW TX
75605-7911
US

IV. Provider business mailing address

1107 E MARSHALL AVE
LONGVIEW TX
75601-5602
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-2610
  • Fax: 903-758-7081
Mailing address:
  • Phone: 903-758-2610
  • Fax: 903-758-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79423
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8779
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79423
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: