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NPI Code Detail

MEDICARE: MRS. PATRICIA LEE GORMAN LPC

MEDICARE: MRS. PATRICIA LEE GORMAN LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor411MN

General Provider Information

NPI Number : 1235351917
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA LEE GORMAN LPC
Provider Business Mailing Address
First Line : 1906 5TH AVE SE
Second Line :
City : LITTLE FALLS
State : MN
Zip : 56345-3317
Country : US
Telephone Number : 320-632-6647
Fax Number :
Provider Business Practice Location Address
First Line : 1906 5TH AVE SE
Second Line :
City : LITTLE FALLS
State : MN
Zip : 56345-3317
Country : US
Telephone Number : 320-632-6647
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 04/06/2018

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