Provider Demographics
NPI:1760407902
Name:GORSUCH, TOM W (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:W
Last Name:GORSUCH
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 BRIAR FOREST DR
Mailing Address - Street 2:NO. 3511
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1000
Mailing Address - Country:US
Mailing Address - Phone:281-705-0996
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:STE. 1010
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:281-705-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00A37LMedicare ID - Type UnspecifiedPSYCHOLOGIST
TXB102640Medicare PIN