Provider Demographics
NPI:1063669075
Name:GORMAN-ANICH, LESLIE J (LMHC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:J
Last Name:GORMAN-ANICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
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Mailing Address - Street 1:117 TREASURE PALM DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7718
Mailing Address - Country:US
Mailing Address - Phone:540-226-1879
Mailing Address - Fax:850-522-9718
Practice Address - Street 1:105 JAZZ DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4906
Practice Address - Country:US
Practice Address - Phone:850-522-9719
Practice Address - Fax:850-522-9718
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9512103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 9512OtherLICENSED MENTAL HEALTH COUNSELOR