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General NPI Number Information
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NPI Number | 1730682907
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Entity Type | Organization
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Legal Business Name | GORDON THERAPEUTIC LLC
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 120 S UNIVERSITY DR STE F
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City | PLANTATION
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State | FL
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Zip | 33324-3346
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Country | US
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Telephone | 754-444-6032
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Fax |
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Provider Business Mailing Address
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Address Line | 814 SW 119TH WAY
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City | DAVIE
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State | FL
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Zip | 33325-3890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SECQUAY GORDON
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Credential | PH.D, LMFT
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Telephone | 754-444-6032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3022
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License Number State | FL
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