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SUSANNE ANNA GORDON MHPP

>> Case Manager/Care Coordinator >> Other Service Providers

Registrant NPI Number: 1679839708

Individual Registrant:
 SUSANNE ANNA GORDON MHPP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
105 CARLTON DR  DUMAS, AR 71639-2836 US
Tel: 870-382-1680  Fax: 870-382-1681

Contact information for business:
105 CARLTON DR  DUMAS, AR 71639-2836 US
Tel: 870-382-1680  Fax: 870-382-1681

Registration Information:
NPI: 1679839708
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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