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General NPI Number Information
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NPI Number | 1891986691
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Entity Type | Individual
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Provider Name | MILTON LEON GORDON M.A.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1117 JASON CIR
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City | ASHLAND CITY
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State | TN
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Zip | 37015-4572
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Country | US
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Telephone | 615-250-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1117 JASON CIR
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City | ASHLAND CITY
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State | TN
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Zip | 37015-4572
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Country | US
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Telephone | 615-574-9579
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6621
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License Number State | TN
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