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NPI Code Detail

MEDICARE: REBECCA GORMAN LPC ASSOCIATE

MEDICARE: REBECCA GORMAN LPC ASSOCIATE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1114739810
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA GORMAN LPC ASSOCIATE
Provider Business Mailing Address
First Line : 4017 E 1ST ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-7003
Country : US
Telephone Number : 432-634-0565
Fax Number :
Provider Business Practice Location Address
First Line : 4017 E 1ST ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76111-7003
Country : US
Telephone Number : 432-634-0565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2025
Last Update Date : 01/21/2025

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Directions to “ REBECCA GORMAN LPC ASSOCIATE” Practice Location

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