Provider Demographics
NPI:1528419785
Name:GORDON, CARLAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLAN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 RIMLAND DR STE 320
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6014
Mailing Address - Country:US
Mailing Address - Phone:360-752-5175
Mailing Address - Fax:
Practice Address - Street 1:2211 RIMLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6014
Practice Address - Country:US
Practice Address - Phone:360-752-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004884103TC0700X
WA61277804103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical