Jacqueline Gordon, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LPCC5007 Issued in CA

Practice address

2445 W Whites Bridge Ave
Fresno, CA 93706-1225

Phone

(559) 264-5096

NPI assigned

Jan 12, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238
  Medicare reassignment Care Compare group NPD
• Comprehensive Addiction Programs Inc

  • Substance Abuse Rehabilitation Facility
  • Fresno, CA
  • NPI 1720221443
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1770949307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2370 W. CLEVELAND AVE.",
            "address_2": "SUITE 108 #320",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "93637",
            "telephone_number": "209-381-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2445 W WHITES BRIDGE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937061225",
            "telephone_number": "559-264-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JACQUELINE",
        "credential": "LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-12",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "LPCC5007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Ray Gorden
• Karla Gordillo
• Wanda Kay Gordon McIntosh, LCSW
• Jolie Marie Gordon-Browar, RN
• Kierra Shaunte Gordon-Smith
• Doris W Gordy, P.A.
• Gorham Family Therapy, Inc
• Ashley Nicole Gorham
• Jeffrey Stephen Gorman, DMD
• Jillian Gorman

• Mental Health Counselor in Fresno, CA
• Providers in Fresno, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.