Active NPI
Heidi Gillmore, LMHCA
- Mental Health Counselor
- Puyallup, WA
National Provider Identifier
1790538320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 61346607
- Practice address
- 5620 112TH St E Ste 215
Puyallup, WA 98373-3206 - Phone
- (253) 444-7176
- NPI assigned
- Apr 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 61346607 | WA | Primary |
Addresses
Primary practice location
5620 112TH St E Ste 215
Puyallup, WA 98373-3206
Mailing address
1501 179TH Street CT E
Spanaway, WA 98387-1953
Phone (319) 480-3454
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61346607 | WA | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bryce Wilson, PLLC | Mental Health | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1712793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712793600000",
"number": "1790538320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 179TH STREET CT E",
"city": "SPANAWAY",
"state": "WA",
"postal_code": "983871953",
"telephone_number": "319-480-3454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5620 112TH ST E STE 215",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983733206",
"telephone_number": "253-444-7176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLMORE",
"first_name": "HEIDI",
"credential": "LMHCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-11",
"last_updated": "2024-04-11",
"certification_date": "2024-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "WA",
"license": "61346607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.