Individual
MR. JERAMIE SOUSA GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PLPC
Contact information
Practice address
104 CRESCENT DR, LEBANON, MO 65536-3301
(417) 588-5885
Mailing address
413 HARMONY RD, SEYMOUR, MO 65746-7223
(417) 935-2799
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2012037683
MO
101YM0800X
Mental Health Counselor
2012037683
MO
101YP2500X
Professional Counselor
Primary
2012037683
MO
Other
Enumeration date
11/05/2012
Last updated
11/05/2012
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