Provider Demographics
NPI:1255541074
Name:GORDON PSYCHOTHERAPY, P.C.
Entity type:Organization
Organization Name:GORDON PSYCHOTHERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - VICE- PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-984-9148
Mailing Address - Street 1:1568 CREEKSIDE DR
Mailing Address - Street 2:SUITE #206
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3449
Mailing Address - Country:US
Mailing Address - Phone:916-984-9148
Mailing Address - Fax:916-933-9068
Practice Address - Street 1:1568 CREEKSIDE DR
Practice Address - Street 2:SUITE #206
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3449
Practice Address - Country:US
Practice Address - Phone:916-984-9148
Practice Address - Fax:916-933-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty