Provider Demographics
NPI:1154565620
Name:GORDON, JESSIE (LPCC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23210 CHAGRIN BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5425
Mailing Address - Country:US
Mailing Address - Phone:440-734-7828
Mailing Address - Fax:216-595-0118
Practice Address - Street 1:23210 CHAGRIN BLVD STE 211
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5425
Practice Address - Country:US
Practice Address - Phone:440-734-7828
Practice Address - Fax:216-595-0118
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional