Provider Demographics
NPI:1972536647
Name:GHORMLEY, MICHAEL R (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:GHORMLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 WIRT RD # 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4916
Mailing Address - Country:US
Mailing Address - Phone:806-748-6400
Mailing Address - Fax:806-748-6110
Practice Address - Street 1:3305 81ST ST
Practice Address - Street 2:STE H
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2042
Practice Address - Country:US
Practice Address - Phone:806-748-6400
Practice Address - Fax:806-748-6110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31739103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86988AOtherBCBS
TX165423803Medicaid
TX165423803Medicaid