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Individual

LYNN MARIE GORDON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
19375 HIGHWAY 116, MONTE RIO, CA 95462
(707) 865-1200
(707) 865-3151
Mailing address
PO BOX 519, MONTE RIO, CA 95462-0519
(707) 865-1200
(707) 865-3151

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
PSB 32692
CA
103T00000X
Psychologist
Primary
PSY 26528
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PSB 32692
PSYCHOLOGICAL ASSISTANT
CA
01
PSY 26528
LICENSED PSYCHOLOGIST
CA
Enumeration date
04/10/2007
Last updated
08/07/2014
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