Provider Demographics
NPI:1245516210
Name:GORDON, CYNTHIA JILL (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JILL
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11128 N 66TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7323
Mailing Address - Country:US
Mailing Address - Phone:720-491-1533
Mailing Address - Fax:
Practice Address - Street 1:11128 N 66TH ST # 1
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7323
Practice Address - Country:US
Practice Address - Phone:720-491-1533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014249101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional