| NPI | 1548872740 |
|---|---|
| Former Name | SHANNEN GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810008539) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2024-12-10 |