Provider Demographics
NPI:1750552675
Name:GORMAN, JAMES E (LMSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:GORMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48805-0592
Mailing Address - Country:US
Mailing Address - Phone:517-416-6341
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:151 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3418
Practice Address - Country:US
Practice Address - Phone:269-968-2811
Practice Address - Fax:269-968-2651
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010677531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883502Medicaid
MI20604OtherBC FACILITY