MEDICARE: MR. MILTON LEON GORDON M.A.

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	101YP2500X	Professional Counselor	6621	TN

General Provider Information

NPI Number	:	1891986691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MILTON LEON GORDON M.A.

Provider Business Mailing Address
First Line	:	1117 JASON CIR
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-4572
Country	:	US
Telephone Number	:	615-574-9579
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 JASON CIR
Second Line	:
City	:	ASHLAND CITY
State	:	TN
Zip	:	37015-4572
Country	:	US
Telephone Number	:	615-250-7200
Fax Number	:

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

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	12/26/2024

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