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NPI Code Detail

MEDICARE: MR. LESLIE MICHAEL GORDON LMFT

MEDICARE: MR. LESLIE MICHAEL GORDON LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMT0001117FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Z2501OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1174758692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LESLIE MICHAEL GORDON LMFT
Provider Business Mailing Address
First Line : 7432 WILES RD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-2066
Country : US
Telephone Number : 954-227-4492
Fax Number : 954-227-4493
Provider Business Practice Location Address
First Line : 7432 WILES RD
Second Line :
City : CORAL SPRINGS
State : FL
Zip : 33067-2066
Country : US
Telephone Number : 954-227-4492
Fax Number : 954-227-4493
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2009
Last Update Date : 05/28/2009

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