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General NPI Number Information
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NPI Number | 1437695491
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Entity Type | Individual
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Provider Name | TAMAR GORDON
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Gender | Female
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 1041 W BRIDGE ST
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-4342
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Country | US
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Telephone | 610-933-8110
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Fax |
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Provider Business Mailing Address
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Address Line | 2432 CHARLESTOWN RD
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City | PHOENIXVILLE
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State | PA
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Zip | 19460-2868
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Country | US
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Telephone | 267-575-4937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC008558
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License Number State | PA
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