Provider Demographics
NPI:1376508945
Name:GORDON SHEPPARD INC.
Entity Type:Organization
Organization Name:GORDON SHEPPARD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GOEDON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-637-5561
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34451-1269
Mailing Address - Country:US
Mailing Address - Phone:352-637-5561
Mailing Address - Fax:352-637-5597
Practice Address - Street 1:1813 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-2412
Practice Address - Country:US
Practice Address - Phone:352-637-5561
Practice Address - Fax:352-637-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNONE1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty