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NPI Code Detail

MEDICARE: MR. PETER MICHAEL GORDON MA - MFT

MEDICARE: MR. PETER MICHAEL GORDON MA - MFT
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 CounselorMFC39863CA

General Provider Information

NPI Number : 1932244662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER MICHAEL GORDON MA - MFT
Provider Business Mailing Address
First Line : 3317 E COLORADO ST
Second Line :
City : LONG BEACH
State : CA
Zip : 90814-2606
Country : US
Telephone Number : 562-826-9009
Fax Number :
Provider Business Practice Location Address
First Line : 4030 E BROADWAY
Second Line :
City : LONG BEACH
State : CA
Zip : 90803-1502
Country : US
Telephone Number : 562-826-9009
Fax Number : 562-987-3538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2007
Last Update Date : 07/08/2007

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