Provider Demographics
NPI:1508350794
Name:LEE-GORDON, TA TANZANIA
Entity Type:Individual
Prefix:
First Name:TA
Middle Name:TANZANIA
Last Name:LEE-GORDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-1421
Mailing Address - Country:US
Mailing Address - Phone:504-483-3558
Mailing Address - Fax:
Practice Address - Street 1:13171 LINDEN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1564
Practice Address - Country:US
Practice Address - Phone:504-957-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health