Provider Demographics
NPI:1063544302
Name:GORDON, LYNN EUVOYNNE (MS, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EUVOYNNE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6484
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-1884
Mailing Address - Country:US
Mailing Address - Phone:307-672-6789
Mailing Address - Fax:307-672-6789
Practice Address - Street 1:40 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4222
Practice Address - Country:US
Practice Address - Phone:307-672-6789
Practice Address - Fax:307-672-6789
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY110101YP2500X
UT5374018-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional