Provider Demographics
NPI:1013229848
Name:GORDON, SUZETTE (LMHC)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6925
Mailing Address - Country:US
Mailing Address - Phone:954-746-5200
Mailing Address - Fax:954-746-5216
Practice Address - Street 1:10001 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6925
Practice Address - Country:US
Practice Address - Phone:954-746-5200
Practice Address - Fax:954-746-5216
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health