Provider Demographics
NPI:1316189996
Name:GORDON, CAMERON L (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:L
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 SAN MARCOS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2308
Mailing Address - Country:US
Mailing Address - Phone:615-373-9955
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-373-9955
Practice Address - Fax:615-373-2001
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4101103TC0700X
TN3529103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical