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General NPI Number Information
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NPI Number | 1831449933
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Entity Type | Individual
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Provider Name | JOHN FRANCIS GORMAN
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Gender | Male
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Dates
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Enumeration Date | 09/16/2012
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Last Update Date | 09/16/2012
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Provider Practice Location Address
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Address Line | 1506 1ST ST
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City | PRINCETON
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State | MN
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Zip | 55371-1462
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Country | US
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Telephone | 763-389-5080
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Fax | 763-389-5453
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Provider Business Mailing Address
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Address Line | 210 15TH AVE N APARTMENT 205
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City | WAITE PARK
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State | MN
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Zip | 56387-1197
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Country | US
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Telephone | 952-201-6490
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 301764
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License Number State | MN
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