Provider Demographics
NPI:1457404014
Name:GORDON, JAMES (PHD, MFT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S BEVERLY DR
Mailing Address - Street 2:#116
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3800
Mailing Address - Country:US
Mailing Address - Phone:310-271-3784
Mailing Address - Fax:310-271-3785
Practice Address - Street 1:204 S BEVERLY DR
Practice Address - Street 2:#116
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3800
Practice Address - Country:US
Practice Address - Phone:310-271-3784
Practice Address - Fax:310-271-3785
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 12651106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA491618Medicare UPIN