Provider Demographics
NPI:1356333595
Name:GORMAN, TANYA JEAN (LADC ACADC CCGC)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:JEAN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LADC ACADC CCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13522 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4223
Mailing Address - Country:US
Mailing Address - Phone:402-871-9028
Mailing Address - Fax:
Practice Address - Street 1:515 E BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4419
Practice Address - Country:US
Practice Address - Phone:712-322-1407
Practice Address - Fax:712-322-6833
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECCGC 021101Y00000X
NELADC101YA0400X
IAACADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)