MEDICARE: MS. DENISE ELLEN GILMOUR M.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC0081	AZ

General Provider Information

NPI Number	:	1538206008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE ELLEN GILMOUR M.C.

Provider Business Mailing Address
First Line	:	3651 E BASELINE RD STE 222
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-5450
Country	:	US
Telephone Number	:	602-409-5237
Fax Number	:	480-539-0621

Provider Business Practice Location Address
First Line	:	3651 E BASELINE RD STE 222
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-5450
Country	:	US
Telephone Number	:	602-409-5237
Fax Number	:	480-539-0621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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