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General NPI Number Information
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NPI Number | 1235806720
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Entity Type | Individual
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Provider Name | TONYA LYNN GORDON LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 15848 JOHNSON ST
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City | INDIANOLA
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State | IA
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Zip | 50125-8450
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Country | US
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Telephone | 515-344-7343
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Fax | 515-608-4692
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Provider Business Mailing Address
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Address Line | 4225 FLEUR DR STE 208
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City | DES MOINES
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State | IA
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Zip | 50321-2325
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Country | US
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Telephone | 515-851-4913
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Fax | 515-297-7551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 108750
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License Number State | IA
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