Provider Demographics
NPI:1063212777
Name:GILLMORE, MELISSA KAY (LPCC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:GILLMORE
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:GORVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 18TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2116
Mailing Address - Country:US
Mailing Address - Phone:507-287-2010
Mailing Address - Fax:507-287-7805
Practice Address - Street 1:4600 18TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2116
Practice Address - Country:US
Practice Address - Phone:507-287-2010
Practice Address - Fax:507-287-7805
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional