Provider Demographics
NPI:1144305996
Name:GORDON, LA FAUNE YVETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:LA FAUNE
Middle Name:YVETTE
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:LA FAUNE
Other - Middle Name:YVETTE
Other - Last Name:GORDON-CONLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1525 AVIATION BLVD # 389
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2805
Mailing Address - Country:US
Mailing Address - Phone:310-281-7359
Mailing Address - Fax:
Practice Address - Street 1:12829 JARVIS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2243
Practice Address - Country:US
Practice Address - Phone:310-281-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical