Provider Demographics
NPI:1346883477
Name:GORNCY, KATHERINE K (TLLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:K
Last Name:GORNCY
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:K
Other - Last Name:HOFMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2847
Mailing Address - Country:US
Mailing Address - Phone:313-356-6878
Mailing Address - Fax:
Practice Address - Street 1:504 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2847
Practice Address - Country:US
Practice Address - Phone:313-356-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007710103TC0700X
MI6301018210103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist