MEDICARE: DR. RUSTY EUGENE GILMORE PH.D.

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	103TC0700X	Clinical Psychologist	PSY36312	CA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY36312	CA

General Provider Information

NPI Number	:	1659576122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSTY EUGENE GILMORE PH.D.

Provider Business Mailing Address
First Line	:	702 MANGROVE AVE STE 277
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3948
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 MANGROVE AVE STE 277
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-3948
Country	:	US
Telephone Number	:	530-514-9800
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	03/02/2026

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