Provider Demographics
NPI:1508948951
Name:GORDON, SUSAN LINDER (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LINDER
Last Name:GORDON
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6365 CLAYTON ROAD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-646-0487
Mailing Address - Fax:314-646-0351
Practice Address - Street 1:6365 CLAYTON ROAD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-646-0487
Practice Address - Fax:314-646-0351
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS001099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
622439OtherUNITED BEHAVIORAL HEALTH
23331OtherBLUE CROSS BLUE SHIELD
561150OtherHEALTHLINK NON PAR
043152196701OtherMERCY HEALTH PLAN
129174OtherVALUEOPTIONS