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NPI Code Detail

MEDICARE: JESSICA A GORDON LMFT

MEDICARE: JESSICA A 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 Therapist85000256AIN

General Provider Information

NPI Number : 1336593268
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA A GORDON LMFT
Provider Business Mailing Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-536-7100
Fax Number : 317-536-7101
Provider Business Practice Location Address
First Line : 1431 N DELAWARE ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2416
Country : US
Telephone Number : 317-536-7100
Fax Number : 317-536-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2016
Last Update Date : 04/18/2016

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Directions to “ JESSICA A GORDON LMFT” Practice Location

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