Provider Demographics
NPI:1689111775
Name:GORDON, HEATHER E (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:LEYLINE EDUCATION DBA GEEK THERAPEUTICS
Mailing Address - Street 2:7801 OAKMONT BLVD STE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4242
Mailing Address - Country:US
Mailing Address - Phone:833-369-1144
Mailing Address - Fax:682-207-1826
Practice Address - Street 1:7210 112TH ST OFC B
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5467
Practice Address - Country:US
Practice Address - Phone:833-369-1144
Practice Address - Fax:682-207-1826
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93631101YP2500X
NY32755101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional