Provider Demographics
NPI:1164155230
Name:GORD, SUZANNE (LPC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:GORD
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 1:1183 CAPTAINS BRG
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-5711
Mailing Address - Country:US
Mailing Address - Phone:937-554-5441
Mailing Address - Fax:
Practice Address - Street 1:376 REGENCY RIDGE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4251
Practice Address - Country:US
Practice Address - Phone:937-232-8026
Practice Address - Fax:937-222-3710
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health