Healthcare Provider Details

I. General information

NPI: 1427852425
Provider Name (Legal Business Name): JANE MARIE GORDON ED.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12843 LANDALE ST
STUDIO CITY CA
91604-1352
US

IV. Provider business mailing address

3943 IRVINE BLVD # 1138
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 818-824-6990
  • Fax:
Mailing address:
  • Phone: 818-824-6990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT152662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: