Provider Demographics
NPI:1942218284
Name:GORDON, CARYN MARIE (LPC, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:MARIE
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6650
Mailing Address - Country:US
Mailing Address - Phone:405-615-9376
Mailing Address - Fax:405-330-2654
Practice Address - Street 1:5500 N WESTERN AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4019
Practice Address - Country:US
Practice Address - Phone:405-615-9376
Practice Address - Fax:405-330-2654
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1125101YP2500X
OK249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist