Provider Demographics
NPI:1184285132
Name:LISA JOY GORDON LLC
Entity type:Organization
Organization Name:LISA JOY GORDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW, CCM
Authorized Official - Phone:248-376-5114
Mailing Address - Street 1:5904 E BRAMBLE BERRY LN
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-1577
Mailing Address - Country:US
Mailing Address - Phone:248-376-5114
Mailing Address - Fax:
Practice Address - Street 1:5904 E BRAMBLE BERRY LN
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-1577
Practice Address - Country:US
Practice Address - Phone:248-376-5114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty