Provider Demographics
NPI:1376848721
Name:GORMAN, STEPHANIE JILL (LPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JILL
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STARR AVENUE
Mailing Address - Street 2:SUITE K
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-648-8477
Mailing Address - Fax:844-235-2943
Practice Address - Street 1:STEPHANIE JILL GORMAN, LPC LLC
Practice Address - Street 2:100 STARR AVENUE SUITE K
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-648-8477
Practice Address - Fax:844-235-2943
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC0006279101YP2500X
MS2210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional