MEDICARE: MR. GORDON HAGBOURNE LCSW, LCDC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	10249	TX
2	101YM0800X	Mental Health Counselor	42670	TX
3	1041C0700X	Clinical Social Worker	42670	TX

General Provider Information

NPI Number	:	1649491564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDON HAGBOURNE LCSW, LCDC

Provider Business Mailing Address
First Line	:	1430 COLLIER ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-2911
Country	:	US
Telephone Number	:	512-445-7787
Fax Number	:	512-440-4059

Provider Business Practice Location Address
First Line	:	3000 OAK SPRINGS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2531
Country	:	US
Telephone Number	:	512-804-3527
Fax Number	:	512-804-3590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/11/2025

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