MEDICARE: JOHN GORIS

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
1	104100000X	Social Worker	S.0019636	OH
2	101YM0800X	Mental Health Counselor	E. 0002873	OH

General Provider Information

NPI Number	:	1407216476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GORIS

Provider Business Mailing Address
First Line	:	1625 S ALEX RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5404
Country	:	US
Telephone Number	:	937-657-9154
Fax Number	:	937-949-6154

Provider Business Practice Location Address
First Line	:	1625 S ALEX RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-5404
Country	:	US
Telephone Number	:	937-657-9154
Fax Number	:	937-949-6154

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2016
Last Update Date	:	09/27/2023

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Directions to “ JOHN GORIS ” Practice Location

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