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NPI Code Detail

MEDICARE: DR. LAURA A GORDON PH.D.

MEDICARE: DR. LAURA A GORDON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0505NM

General Provider Information

NPI Number : 1164434262
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAURA A GORDON PH.D.
Provider Business Mailing Address
First Line : PO BOX 16186
Second Line :
City : LAS CRUCES
State : NM
Zip : 88004-6186
Country : US
Telephone Number : 505-649-9224
Fax Number :
Provider Business Practice Location Address
First Line : 1681 HICKORY LOOP
Second Line : STE. A
City : LAS CRUCES
State : NM
Zip : 88005-6587
Country : US
Telephone Number : 505-649-9224
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 07/08/2007

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