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General NPI Number Information
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NPI Number | 1043047269
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Entity Type | Individual
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Provider Name | DEVON KB GORMAN
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Gender | Female
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | PO BOX 457
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City | GANADO
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State | AZ
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Zip | 86505-0457
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Country | US
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Telephone | 928-755-4586
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Fax | 928-755-4747
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Provider Business Mailing Address
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Address Line | PO BOX 52
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City | CHINLE
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State | AZ
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Zip | 86503-0052
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Country | US
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Telephone | 480-401-6166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-22971
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License Number State | AZ
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