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NPI Code Detail

MEDICARE: GORDON COUNSELING AND CONSULTING, LLC

MEDICARE: GORDON COUNSELING AND CONSULTING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1099MO

General Provider Information

NPI Number : 1225202641
Entity Type Code : Organization
Provider Name (Legal Business Name) : GORDON COUNSELING AND CONSULTING, LLC
Provider Business Mailing Address
First Line : 6365 CLAYTON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1808
Country : US
Telephone Number : 314-646-0487
Fax Number :
Provider Business Practice Location Address
First Line : 6365 CLAYTON RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1808
Country : US
Telephone Number : 314-646-0487
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. SUSAN L GORDON
Credential : LPC
Telephone Number : 314-646-0487
Provider Enumeration Date : 04/16/2008
Last Update Date : 04/16/2008

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Directions to “GORDON COUNSELING AND CONSULTING, LLC ” Practice Location

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