Provider Demographics
NPI:1972848711
Name:GORMAN, DOUGLAS PAUL JR (MHC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:PAUL
Last Name:GORMAN
Suffix:JR
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7213 N DUNCAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5407
Mailing Address - Country:US
Mailing Address - Phone:401-497-2180
Mailing Address - Fax:
Practice Address - Street 1:6323 MEMORIAL HWY BLDG A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4509
Practice Address - Country:US
Practice Address - Phone:813-891-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8949101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health