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General NPI Number Information
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NPI Number | 1770949307
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Entity Type | Individual
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Provider Name | JACQUELINE GORDON LPCC
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 2445 W WHITES BRIDGE AVE
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City | FRESNO
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State | CA
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Zip | 93706-1225
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Country | US
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Telephone | 559-264-5096
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 W. CLEVELAND AVE. SUITE 108 #320
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City | MADERA
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State | CA
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Zip | 93637
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Country | US
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Telephone | 209-381-6800
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPCC5007
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License Number State | CA
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