Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 201263 | TX |
NPI | 1003186164 |
---|---|
Provider Name | Teandra Vashon Gordon |
First Address | Houston, TX 77266 |
Second Address | Houston, TX 77006-2602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2012 |
Last Update Date | 26/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080462703 | (05) | TX |