Provider Demographics
NPI:1508508375
Name:O'GORMAN, KASSIDI (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KASSIDI
Middle Name:
Last Name:O'GORMAN
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 YALE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5168
Mailing Address - Country:US
Mailing Address - Phone:530-966-0965
Mailing Address - Fax:
Practice Address - Street 1:8310 YALE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5168
Practice Address - Country:US
Practice Address - Phone:530-966-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional