Doctor Name: | TERRI L. GORMAN |
NPI Number: | 1114258670 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 993001 |
Business Practice Address: | 1335 Phay Ave Suite H Canon City, CO - 812122334 |
Business Phone Number: | 7197847522 |
Business Fax Number: | 7197847522 |
Mailing Address: | Po Box 681, PENROSE |
State: | CO |
Postal Code: | 812400681 |
Phone Number: | 7197847522 |
Fax Number: | 7197847522 |
NPI Enumeration Date: | 01/23/2010 |
NPI Last Update Date: | 12/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 993001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |