Active NPI
Jonathan Paul Gorham, PSY.D.
- Clinical Psychologist
- Dyess Afb, TX
National Provider Identifier
1679754055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 019063-1
- Practice address
- 697 Louisiana Dr.
Dyess Afb, TX 79607 - Phone
- (325) 696-5380
- Fax
- (352) 696-5579
- NPI assigned
- Nov 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 019063-1 | NY | Primary |
Addresses
Primary practice location
697 Louisiana Dr.
Dyess Afb, TX 79607
Mailing address
697 Louisiana Dr.
Dyess Afb, TX 79607
Phone (325) 696-5380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019063-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306108800000",
"number": "1679754055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "697 LOUISIANA DR.",
"city": "DYESS AFB",
"state": "TX",
"postal_code": "79607",
"telephone_number": "325-696-5380",
"fax_number": "352-696-5579"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "697 LOUISIANA DR.",
"city": "DYESS AFB",
"state": "TX",
"postal_code": "79607",
"telephone_number": "325-696-5380",
"fax_number": "352-696-5579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORHAM",
"first_name": "JONATHAN",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-11-14",
"last_updated": "2011-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "019063-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyess Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.