MEDICARE: MR. GORDON DEAN BATHEL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-0167	AZ
2	1041C0700X	Clinical Social Worker	LCSW-0974	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215959192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDON DEAN BATHEL LCSW

Provider Business Mailing Address
First Line	:	5210 E PIMA ST STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-3691
Country	:	US
Telephone Number	:	520-275-6780
Fax Number	:	520-795-3575

Provider Business Practice Location Address
First Line	:	5210 E PIMA ST
Second Line	:	SUITE #140
City	:	TUCSON
State	:	AZ
Zip	:	85712-3664
Country	:	US
Telephone Number	:	520-275-6780
Fax Number	:	520-795-3575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	04/18/2020

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