Basic Information
| Provider Information | |||||||||
| NPI: | 1609416379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILMORE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 NE LOOP 410 STE 200 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782165844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108261830 | ||||||||
| FaxNumber: | 2108261840 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PEACEFUL LN | ||||||||
| Address2: | |||||||||
| City: | CONVERSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781091007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102489077 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2020 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 60870 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.