Healthcare Provider Details

I. General information

NPI: 1629990643
Provider Name (Legal Business Name): ANNA CLAIRE GORHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WAKARUSA DR STE 102
LAWRENCE KS
66047-2082
US

IV. Provider business mailing address

1811 WAKARUSA DR STE 102
LAWRENCE KS
66047-2082
US

V. Phone/Fax

Practice location:
  • Phone: 785-371-4921
  • Fax: 888-965-5147
Mailing address:
  • Phone: 785-371-4921
  • Fax: 888-965-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number03556
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: