Healthcare Provider Details

I. General information

NPI: 1649186461
Provider Name (Legal Business Name): LAWRENCE GORMAN III CHW-CRS, CPSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N MERIDIAN ST STE 106
INDIANAPOLIS IN
46204-1420
US

IV. Provider business mailing address

777 N MERIDIAN ST STE 106
INDIANAPOLIS IN
46204-1420
US

V. Phone/Fax

Practice location:
  • Phone: 317-629-9849
  • Fax:
Mailing address:
  • Phone: 317-629-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: