Provider Demographics
NPI:1306520986
Name:GORDON, HALROY
Entity type:Individual
Prefix:
First Name:HALROY
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13925 W MEEKER BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4431
Mailing Address - Country:US
Mailing Address - Phone:623-230-4555
Mailing Address - Fax:
Practice Address - Street 1:13925 W MEEKER BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4431
Practice Address - Country:US
Practice Address - Phone:623-230-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health