Provider Demographics
NPI:1386992535
Name:GORCHOFF, REBECCA KELLY (LMHC, RMHCI)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:KELLY
Last Name:GORCHOFF
Suffix:
Gender:F
Credentials:LMHC, RMHCI
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:KELLY
Other - Last Name:SPIGENER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, RMHCI
Mailing Address - Street 1:5178 KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2734
Mailing Address - Country:US
Mailing Address - Phone:954-648-3974
Mailing Address - Fax:
Practice Address - Street 1:2900 N UNIVERSITY DR STE 30
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5083
Practice Address - Country:US
Practice Address - Phone:954-648-3974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT1752101Y00000X
FLMH 13360101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070525000Medicaid