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General NPI Number Information
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NPI Number | 1356333595
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Entity Type | Individual
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Provider Name | TANYA JEAN GORMAN LADC ACADC CCGC
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Gender | Female
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 515 E BROADWAY
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-4419
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Country | US
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Telephone | 712-322-1407
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Fax | 712-322-6833
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Provider Business Mailing Address
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Address Line | 13522 BIRCHWOOD AVE
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City | OMAHA
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State | NE
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Zip | 68137-4223
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Country | US
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Telephone | 402-871-9028
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CCGC 021
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LADC
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACADC
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License Number State | IA
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