Provider Demographics
NPI:1124105317
Name:GORDON, DENISE (LMFT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26300 LA ALAMEDA
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6317
Mailing Address - Country:US
Mailing Address - Phone:949-207-3416
Mailing Address - Fax:
Practice Address - Street 1:26300 LA ALAMEDA
Practice Address - Street 2:SUITE 280
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6317
Practice Address - Country:US
Practice Address - Phone:949-207-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46169106H00000X
CA46169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist