Provider Demographics
NPI:1861619223
Name:GORDON, YVONNE ANN (MA, MFTI)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:ANN
Last Name:GORDON
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 TRAFALGAR CIR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3173
Mailing Address - Country:US
Mailing Address - Phone:209-957-9001
Mailing Address - Fax:209-957-9004
Practice Address - Street 1:1341 W ROBINHOOD DR
Practice Address - Street 2:SUITE B10
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5515
Practice Address - Country:US
Practice Address - Phone:209-957-9001
Practice Address - Fax:209-957-9004
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47083106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist