MEDICARE: DMOUCHELLE GORE LLPC

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	6451017171	MI

General Provider Information

NPI Number	:	1639883184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DMOUCHELLE GORE LLPC

Provider Business Mailing Address
First Line	:	2150 MARTIN LUTHER KING JR BLVD APT 204
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-2669
Country	:	US
Telephone Number	:	313-770-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 E GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3513
Country	:	US
Telephone Number	:	313-833-5614
Fax Number	:

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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Directions to “ DMOUCHELLE GORE LLPC” Practice Location

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