Provider Demographics
NPI:1487815072
Name:GORDON, ROBERT (JD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 NOEL RD
Mailing Address - Street 2:SUITE 1910
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6602
Mailing Address - Country:US
Mailing Address - Phone:972-620-0230
Mailing Address - Fax:972-243-5879
Practice Address - Street 1:13355 NOEL ROAD
Practice Address - Street 2:SUITE 1910
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-620-0230
Practice Address - Fax:972-243-5879
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical