Provider Demographics
NPI:1801273131
Name:GORTON, CYNTHIA (LMFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:GORTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N CLOVERDALE BLVD STE 10
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-3384
Mailing Address - Country:US
Mailing Address - Phone:707-404-3178
Mailing Address - Fax:
Practice Address - Street 1:129 N CLOVERDALE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3384
Practice Address - Country:US
Practice Address - Phone:707-404-3178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62750106H00000X
CA98734106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist