Healthcare Provider Details

I. General information

NPI: 1245134147
Provider Name (Legal Business Name): JAMES GORDON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 E 38TH ST
INDIANAPOLIS IN
46226-5614
US

IV. Provider business mailing address

6002 E 38TH ST
INDIANAPOLIS IN
46226-5614
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-8491
  • Fax:
Mailing address:
  • Phone: 317-880-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34013250A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: