Provider Demographics
NPI:1063502532
Name:GHORMLEY, COURTNEY O (PHD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:O
Last Name:GHORMLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MCKINLEY ST
Mailing Address - Street 2:SUITE 645
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3013
Mailing Address - Country:US
Mailing Address - Phone:501-661-1700
Mailing Address - Fax:866-521-5490
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:SUITE 645
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-661-1700
Practice Address - Fax:866-521-5490
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR06-03P103G00000X, 103TC0700X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
5Y765Medicare PIN