Provider Demographics
NPI:1053552539
Name:GORMAN COUNSELING SERVICES PC
Entity type:Organization
Organization Name:GORMAN COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-608-0545
Mailing Address - Street 1:3233 E MEMORIAL RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7082
Mailing Address - Country:US
Mailing Address - Phone:405-608-0545
Mailing Address - Fax:405-286-4093
Practice Address - Street 1:3233 E MEMORIAL RD
Practice Address - Street 2:STE. 110
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-7082
Practice Address - Country:US
Practice Address - Phone:405-608-0545
Practice Address - Fax:405-286-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty