Provider Demographics
NPI:1871542910
Name:GORDON COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:GORDON COUNSELING CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:254-396-4330
Mailing Address - Street 1:1798 FM 914
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-6221
Mailing Address - Country:US
Mailing Address - Phone:254-396-4330
Mailing Address - Fax:254-965-5372
Practice Address - Street 1:222B E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-4303
Practice Address - Country:US
Practice Address - Phone:254-396-4330
Practice Address - Fax:254-965-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty