Provider Demographics
NPI:1386629376
Name:GORA, JESSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:GORA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4659 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4909
Mailing Address - Country:US
Mailing Address - Phone:801-532-7414
Mailing Address - Fax:
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:SUITE 105
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-532-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50251392501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107029545101OtherU006
UT8573690OtherU002
UT942938348015OtherU009
UTQ11013OtherICAR