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NPI Code Detail

MEDICARE: LAUREN GORDON LCSW

MEDICARE:   LAUREN  GORDON  LCSW
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
1101YM0800XMental Health Counselor52617TX

General Provider Information

NPI Number : 1427671817
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN GORDON LCSW
Provider Business Mailing Address
First Line : 8301 LAKEVIEW PKWY # 111-131
Second Line :
City : ROWLETT
State : TX
Zip : 75088-9320
Country : US
Telephone Number : 214-675-3978
Fax Number :
Provider Business Practice Location Address
First Line : 2411 WESLEY ST STE 303
Second Line :
City : GREENVILLE
State : TX
Zip : 75401-3368
Country : US
Telephone Number : 214-675-3978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2020
Last Update Date : 05/20/2020

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Directions to “ LAUREN GORDON LCSW” Practice Location

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