Provider Demographics
NPI:1063535573
Name:GORMAN, STEPHANIE KAY (MFT)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:KAY
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65565 ACOMA AVE SPC 89
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3519
Mailing Address - Country:US
Mailing Address - Phone:760-347-0494
Mailing Address - Fax:760-347-9064
Practice Address - Street 1:65565 ACOMA AVE SPC 89
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3519
Practice Address - Country:US
Practice Address - Phone:760-347-9064
Practice Address - Fax:760-347-9064
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 54110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist