Provider Demographics
NPI:1407271869
Name:GORDON, KRISTEN (MA, LPC INTERN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 OAK VIEW MDWS
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-2706
Mailing Address - Country:US
Mailing Address - Phone:281-324-1052
Mailing Address - Fax:
Practice Address - Street 1:9511 N HIGHWAY 146
Practice Address - Street 2:
Practice Address - City:MONT BELVIEU
Practice Address - State:TX
Practice Address - Zip Code:77523-9677
Practice Address - Country:US
Practice Address - Phone:281-576-2444
Practice Address - Fax:281-576-4506
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional