Individual
DR. JONATHAN PAUL GORHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
697 LOUISIANA DR., DYESS AFB, TX 79607
(325) 696-5380
(352) 696-5579
Mailing address
697 LOUISIANA DR., DYESS AFB, TX 79607
(325) 696-5380
(352) 696-5579
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019063-1
NY
Other
Enumeration date
11/14/2007
Last updated
05/23/2011
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