Individual
MRS. TINA RENEE GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
704 N OAK AVE STE 20, ADA, OK 74820-3267
(580) 332-3001
(580) 332-3652
Mailing address
704 N OAK AVE STE 20, ADA, OK 74820-3267
(580) 332-3001
(580) 332-3652
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100732530A
—
OK
Enumeration date
08/09/2010
Last updated
08/09/2010
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