Provider Demographics
NPI:1194121913
Name:GORDON, JENNI RENE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JENNI
Middle Name:RENE
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JENNI
Other - Middle Name:RENE
Other - Last Name:ODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:353 PARK MARINA CIR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-0965
Mailing Address - Country:US
Mailing Address - Phone:530-355-0115
Mailing Address - Fax:530-245-9222
Practice Address - Street 1:1400 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1620
Practice Address - Country:US
Practice Address - Phone:530-232-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist