Provider Demographics
NPI:1861766586
Name:GORDON, JUSTIN (LMFT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336W 3162 S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8352
Mailing Address - Country:US
Mailing Address - Phone:435-215-3184
Mailing Address - Fax:435-652-8334
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:SUITE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4023
Practice Address - Country:US
Practice Address - Phone:435-215-3184
Practice Address - Fax:435-652-8334
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8017789-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist