Provider Demographics
NPI:1437404100
Name:O'GORMAN, KELLEY KAY (LPC)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:KAY
Last Name:O'GORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 SW HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1042
Mailing Address - Country:US
Mailing Address - Phone:503-989-9600
Mailing Address - Fax:
Practice Address - Street 1:1423 SW HALSEY ST
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-1042
Practice Address - Country:US
Practice Address - Phone:503-989-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional