Provider Demographics
NPI:1407006406
Name:GORMAN, HEATHER RENEE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26137 LA PAZ RD
Mailing Address - Street 2:#230
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5319
Mailing Address - Country:US
Mailing Address - Phone:949-595-8610
Mailing Address - Fax:
Practice Address - Street 1:26137 LA PAZ RD
Practice Address - Street 2:#230
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5319
Practice Address - Country:US
Practice Address - Phone:949-595-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health