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General NPI Number Information
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NPI Number | 1992519144
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Entity Type | Individual
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Provider Name | JONATHAN ADAM GORDON
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Gender | Male
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 8100 E 22ND ST N BLDG 2300-3
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City | WICHITA
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State | KS
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Zip | 67226-2306
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Country | US
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Telephone | 513-680-5499
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 N ROOSEVELT ST
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City | WICHITA
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State | KS
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Zip | 67220-2809
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 04963
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License Number State | KS
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