Provider Demographics
NPI:1982564878
Name:GORGES, NICHOLAS J
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:GORGES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 N LAKE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-5209
Mailing Address - Country:US
Mailing Address - Phone:316-347-9161
Mailing Address - Fax:
Practice Address - Street 1:6617 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3385
Practice Address - Country:US
Practice Address - Phone:316-201-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist