Healthcare Provider Details

I. General information

NPI: 1649491564
Provider Name (Legal Business Name): GORDON HAGBOURNE LCSW, LCDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OAK SPRINGS DR
AUSTIN TX
78702-2531
US

IV. Provider business mailing address

1430 COLLIER ST
AUSTIN TX
78704-2911
US

V. Phone/Fax

Practice location:
  • Phone: 512-804-3527
  • Fax: 512-804-3590
Mailing address:
  • Phone: 512-445-7787
  • Fax: 512-440-4059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10249
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number42670
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number42670
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: