Healthcare Provider Details

I. General information

NPI: 1194214593
Provider Name (Legal Business Name): MARTHA GORDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GRAPHICS WAY STE 3100
LEWIS CENTER OH
43035-0238
US

IV. Provider business mailing address

299 CRAMER CREEK CT
DUBLIN OH
43017-2586
US

V. Phone/Fax

Practice location:
  • Phone: 740-428-0428
  • Fax: 740-909-4077
Mailing address:
  • Phone: 614-600-2708
  • Fax: 614-476-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1200085
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: