Provider Demographics
NPI:1164434262
Name:GORDON, LAURA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16186
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-6186
Mailing Address - Country:US
Mailing Address - Phone:505-649-9224
Mailing Address - Fax:
Practice Address - Street 1:1681 HICKORY LOOP
Practice Address - Street 2:STE. A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-6587
Practice Address - Country:US
Practice Address - Phone:505-649-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0505101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health