MEDICARE: GORHAM PSYCHOTHERAPY PC DBA TOWNSEND THERAPY SERVICES

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1760122972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORHAM PSYCHOTHERAPY PC DBA TOWNSEND THERAPY SERVICES

Provider Business Mailing Address
First Line	:	820 W DANFORTH RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5006
Country	:	US
Telephone Number	:	405-930-3389
Fax Number	:	405-930-3398

Provider Business Practice Location Address
First Line	:	820 W DANFORTH RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5006
Country	:	US
Telephone Number	:	405-930-3389
Fax Number	:	405-930-3398

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY GORHAM
Credential	:
Telephone Number	:	209-840-2303

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	01/09/2023

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