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General NPI Number Information
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NPI Number | 1871948968
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Entity Type | Individual
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Provider Name | SECQUAY S GORDON LMFT
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Gender | Male
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 1420 SW 82ND AVE
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City | PLANTATION
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State | FL
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Zip | 33324-6544
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Country | US
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Telephone | 954-554-2585
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Fax | 305-681-2500
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Provider Business Mailing Address
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Address Line | 1420 SW 82ND AVE
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City | PLANTATION
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State | FL
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Zip | 33324-3258
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Country | US
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Telephone | 954-554-2585
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Fax | 305-681-2500
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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 | 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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