Provider Demographics
NPI:1255041786
Name:BACH-GORMAN, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BACH-GORMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:3227 OAK RIDGE LOOP E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8482
Mailing Address - Country:US
Mailing Address - Phone:701-419-8702
Mailing Address - Fax:701-520-8457
Practice Address - Street 1:3227 OAK RIDGE LOOP E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8482
Practice Address - Country:US
Practice Address - Phone:701-419-8702
Practice Address - Fax:701-520-8457
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional