Provider Demographics
NPI:1366640047
Name:KIMBERLY S. GORMAN, PH.D., P.C.
Entity type:Organization
Organization Name:KIMBERLY S. GORMAN, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-254-1985
Mailing Address - Street 1:800 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3863
Mailing Address - Country:US
Mailing Address - Phone:765-254-1985
Mailing Address - Fax:
Practice Address - Street 1:800 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3863
Practice Address - Country:US
Practice Address - Phone:765-254-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041566A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN202230Medicare ID - Type Unspecified
P-16678Medicare UPIN