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General NPI Number Information
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NPI Number | 1669714887
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Entity Type | Individual
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Provider Name | TANIA GORHAM MS, LMFT, QS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 1950 LEE RD STE 110
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City | WINTER PARK
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State | FL
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Zip | 32789-1847
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Country | US
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Telephone | 407-561-3459
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Fax | 321-296-6847
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Provider Business Mailing Address
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Address Line | 2882 GLENRIDGE CIR
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-2955
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Country | US
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Telephone | 321-013-3295
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3161
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License Number State | FL
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