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NPI Code Detail

MEDICARE: MRS. TRISHA GORGOL BCBA

MEDICARE: MRS. TRISHA GORGOL BCBA
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
1103K00000XBehavior Analyst1-12-11531FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952645624
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRISHA GORGOL BCBA
Provider Business Mailing Address
First Line : PO BOX 51322
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42102-5622
Country : US
Telephone Number : 270-777-9283
Fax Number : 270-777-9283
Provider Business Practice Location Address
First Line : 5447 E BEAUMONT CENTER BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33634-5210
Country : US
Telephone Number : 888-754-0398
Fax Number : 954-982-6491
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 11/02/2021

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