Provider Demographics
NPI:1841389145
Name:GORMAN, KATHERINE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:J
Last Name:GORMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6159 HOODS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-5918
Mailing Address - Country:US
Mailing Address - Phone:615-934-1488
Mailing Address - Fax:931-647-9870
Practice Address - Street 1:6159 HOODS BRANCH RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-5918
Practice Address - Country:US
Practice Address - Phone:615-934-1488
Practice Address - Fax:931-647-9870
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000002446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3983100Medicaid
TN3983100Medicaid