Healthcare Provider Details

I. General information

NPI: 1619047040
Provider Name (Legal Business Name): JOANN GORDON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1643 LEWIS AVE SUITE #3 OFFICE 6
BILLINGS MT
59102-4151
US

IV. Provider business mailing address

1643 LEWIS AVE SUITE #3 OFFICE 6
BILLINGS MT
59102-4151
US

V. Phone/Fax

Practice location:
  • Phone: 406-256-3577
  • Fax: 406-294-0967
Mailing address:
  • Phone: 406-256-3577
  • Fax: 406-294-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number348LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: