Provider Demographics
NPI:1255479416
Name:GORDON, JANET (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:BURRESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:237 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1403
Mailing Address - Country:US
Mailing Address - Phone:909-388-5600
Mailing Address - Fax:909-386-5289
Practice Address - Street 1:237 W MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1403
Practice Address - Country:US
Practice Address - Phone:909-388-5600
Practice Address - Fax:909-386-5289
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist