Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | MH 9512 | FL |
NPI | 1063669075 |
---|---|
Provider Name | Dr. Leslie J. Gorman-Anich |
First Address | Panama City Beach, FL 32408-7718 |
Second Address | Panama City, FL 32405-4906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MH 9512 | LICENSED MENTAL HEALTH COUNSELOR (01) | FL |