Healthcare Provider Details

I. General information

NPI: 1073156113
Provider Name (Legal Business Name): ELIZABETH GORDON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16216 BAXTER RD STE 205
CHESTERFIELD MO
63017-4778
US

IV. Provider business mailing address

16216 BAXTER RD STE 205
CHESTERFIELD MO
63017-4778
US

V. Phone/Fax

Practice location:
  • Phone: 636-532-9188
  • Fax: 636-532-9951
Mailing address:
  • Phone: 636-532-9188
  • Fax: 636-532-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021047101
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: