Provider Demographics
NPI:1194137810
Name:GILLMORE, TASHENNA J (MED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:TASHENNA
Middle Name:J
Last Name:GILLMORE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:TASHENNA
Other - Middle Name:J
Other - Last Name:HOWK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 COLORADO BLVD
Mailing Address - Street 2:#52115
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76206-2902
Mailing Address - Country:US
Mailing Address - Phone:214-608-7120
Mailing Address - Fax:940-383-9669
Practice Address - Street 1:6399 FISHTRAP RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-1607
Practice Address - Country:US
Practice Address - Phone:214-608-7120
Practice Address - Fax:940-243-8195
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-14882103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst