Healthcare Provider Details

I. General information

NPI: 1346787249
Provider Name (Legal Business Name): PORTIA GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 BELLEMEADE BLVD
GRETNA LA
70056-7631
US

IV. Provider business mailing address

783 BELLEMEADE BLVD
GRETNA LA
70056-7631
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-4189
  • Fax:
Mailing address:
  • Phone: 504-533-4189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5620
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: