Provider Demographics
NPI:1790882389
Name:GORDON, JEENIE NMN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JEENIE
Middle Name:NMN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JEENIE
Other - Middle Name:NMN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1175 E GARVEY ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3677
Mailing Address - Country:US
Mailing Address - Phone:626-967-6421
Mailing Address - Fax:626-967-9670
Practice Address - Street 1:1175 E GARVEY ST
Practice Address - Street 2:SUITE 250
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3677
Practice Address - Country:US
Practice Address - Phone:626-967-6421
Practice Address - Fax:626-967-9670
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist