Provider Demographics
NPI:1215949847
Name:GORJI, THOMAS N (LMHP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:N
Last Name:GORJI
Suffix:
Gender:M
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 M ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2233
Mailing Address - Country:US
Mailing Address - Phone:402-560-4000
Mailing Address - Fax:402-476-6110
Practice Address - Street 1:825 M ST
Practice Address - Street 2:SUITE 314
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-2233
Practice Address - Country:US
Practice Address - Phone:402-560-4000
Practice Address - Fax:402-476-6110
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082917826Medicaid