Provider Demographics
NPI:1700323037
Name:GOHRBAND, JEFFREY (LMSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GOHRBAND
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 1:805 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1901
Mailing Address - Country:US
Mailing Address - Phone:734-883-0711
Mailing Address - Fax:517-266-8881
Practice Address - Street 1:110 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5503
Practice Address - Country:US
Practice Address - Phone:734-544-3000
Practice Address - Fax:734-544-6716
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011006141041C0700X
MI68011051061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30305Medicaid