Individual
LOGAN THOMAS GILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 858-2365
Mailing address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 858-2365
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-40248
ID
Other
Enumeration date
05/02/2021
Last updated
09/25/2023
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