Provider Demographics
NPI:1033496823
Name:GORMAN, DONNA MARIE (LCMFT, LCAC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCMFT, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 W MAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3505
Mailing Address - Country:US
Mailing Address - Phone:316-262-0505
Mailing Address - Fax:316-262-7384
Practice Address - Street 1:1319 W MAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3505
Practice Address - Country:US
Practice Address - Phone:316-262-0505
Practice Address - Fax:316-262-7384
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist