MEDICARE: GENERATIONS DANCE PSYCHOTHERAPY, PLLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1770433187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS DANCE PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	1131 236TH PL NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7297
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1131 236TH PL NE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98074-7297
Country	:	US
Telephone Number	:	585-524-6218
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAITLYN GILMORE
Credential	:	MA, LMHC
Telephone Number	:	585-524-6218

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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