| Doctor Name: | COREY JAMES GORDER |
| NPI Number: | 1588800882 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPCC |
| License Number: | 569-12-15-06-190 |
| Business Practice Address: | 104 11th St W Ste. 4 Bottineau, ND - 583182005 |
| Business Phone Number: | 7012010076 |
| Business Fax Number: | |
| Mailing Address: | 10275 Sjule Rd, BOTTINEAU |
| State: | ND |
| Postal Code: | 583187009 |
| Phone Number: | 7012010076 |
| Fax Number: | |
| NPI Enumeration Date: | 12/17/2008 |
| NPI Last Update Date: | 01/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | 569-12-15-06-190 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ND |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |