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General NPI Number Information
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NPI Number | 1184285132
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Entity Type | Organization
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Legal Business Name | LISA JOY GORDON LLC
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Dates
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Enumeration Date | 06/20/2019
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Last Update Date | 09/27/2020
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Provider Practice Location Address
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Address Line | 5904 E BRAMBLE BERRY LN
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City | CAVE CREEK
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State | AZ
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Zip | 85331-1577
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Country | US
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Telephone | 248-376-5114
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Fax |
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Provider Business Mailing Address
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Address Line | 5904 E BRAMBLE BERRY LN
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City | CAVE CREEK
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State | AZ
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Zip | 85331-1577
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Country | US
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Telephone | 248-376-5114
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Fax |
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Authorized Official
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Title or Position | LCSW / OWNER
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Name | LISA JOY GORDON
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Credential | LCSW, ACSW, CCM
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Telephone | 248-376-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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