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Individual

MR. COLT GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW 110973

Contact information

Practice address
627 15TH ST, CODY, WY 82414-3109
(619) 453-5063
Mailing address
627 15TH ST, CODY, WY 82414-3109
(619) 453-5063

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
110973
CA
1041C0700X
Clinical Social Worker
1577
WY

Other

Enumeration date
11/20/2020
Last updated
01/31/2024
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