Provider Demographics
NPI:1417276874
Name:GORDON, TREVOR ALLAN JR (BHRS/BS)
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:ALLAN
Last Name:GORDON
Suffix:JR
Gender:M
Credentials:BHRS/BS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7901 NE 10TH ST STE C116
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3653
Mailing Address - Country:US
Mailing Address - Phone:405-532-6316
Mailing Address - Fax:405-455-7122
Practice Address - Street 1:7901 NE 10TH ST STE C116
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3653
Practice Address - Country:US
Practice Address - Phone:405-532-6316
Practice Address - Fax:405-455-7122
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst