MEDICARE: JACLYN GORMAN LPCC

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	101YP2500X	Professional Counselor		OH

General Provider Information

NPI Number	:	1528795697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN GORMAN LPCC

Provider Business Mailing Address
First Line	:	3675 ROLLISTON RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-5136
Country	:	US
Telephone Number	:	702-425-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 FAIRMOUNT BLVD STE 324
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3164
Country	:	US
Telephone Number	:	614-328-9714
Fax Number	:

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	05/29/2025

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