Provider Demographics
NPI:1831449933
Name:GORMAN, JOHN FRANCIS
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
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 1:210 15TH AVE N
Mailing Address - Street 2:APARTMENT 205
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1197
Mailing Address - Country:US
Mailing Address - Phone:952-201-6490
Mailing Address - Fax:
Practice Address - Street 1:1506 1ST ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1462
Practice Address - Country:US
Practice Address - Phone:763-389-5080
Practice Address - Fax:763-389-5453
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)