Provider Demographics
NPI:1083775290
Name:GORCHOW, SANDRA T (MS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:T
Last Name:GORCHOW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 5TH AVE
Mailing Address - Street 2:SUITE 228
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2762
Mailing Address - Country:US
Mailing Address - Phone:541-222-9350
Mailing Address - Fax:
Practice Address - Street 1:207 E 5TH AVE
Practice Address - Street 2:SUITE 228
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2762
Practice Address - Country:US
Practice Address - Phone:541-222-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43561106H00000X
ORT0972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist