Provider Demographics
NPI:1851464960
Name:GORMAN, GRANT PATRICK
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:PATRICK
Last Name:GORMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MISSION ST
Mailing Address - Street 2:SUITE V
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 HIXON RD
Practice Address - Street 2:
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2617
Practice Address - Country:US
Practice Address - Phone:805-969-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health