Provider Demographics
NPI:1417201187
Name:GORDON, MEGHAN DEMMA (MED LPCC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:DEMMA
Last Name:GORDON
Suffix:
Gender:F
Credentials:MED LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15810 E TALL TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4347
Mailing Address - Country:US
Mailing Address - Phone:720-841-4167
Mailing Address - Fax:
Practice Address - Street 1:15810 E TALL TIMBER LN
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4347
Practice Address - Country:US
Practice Address - Phone:720-841-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14216101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health