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NPI Code Detail

MEDICARE: MS. KARLA JEAN GILMORE BSW, LAT

MEDICARE: MS. KARLA JEAN GILMORE BSW, LAT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor169AWY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1310825OTHERBS

General Provider Information

NPI Number : 1548268659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KARLA JEAN GILMORE BSW, LAT
Provider Business Mailing Address
First Line : 510 W 29TH ST
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-2760
Country : US
Telephone Number : 307-632-9362
Fax Number :
Provider Business Practice Location Address
First Line : 510 W 29TH ST
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-2760
Country : US
Telephone Number : 307-632-9362
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 03/23/2015

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