Provider Demographics
NPI:1982221727
Name:GORDON, SHAWN (LMFT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LEE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1847
Mailing Address - Country:US
Mailing Address - Phone:352-639-4337
Mailing Address - Fax:
Practice Address - Street 1:1950 LEE RD STE 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1847
Practice Address - Country:US
Practice Address - Phone:352-639-4337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-27
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3783106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist