Provider Demographics
NPI:1134965833
Name:GORDON, TRUDY-ANN (APPC)
Entity type:Individual
Prefix:MS
First Name:TRUDY-ANN
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:APPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28494 WESTINGHOUSE PL STE 304
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0935
Mailing Address - Country:US
Mailing Address - Phone:323-476-0691
Mailing Address - Fax:
Practice Address - Street 1:28494 WESTINGHOUSE PL STE 304
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0935
Practice Address - Country:US
Practice Address - Phone:323-476-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC16705101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health