Doctor Name: | MISS MIMS GORDON |
NPI Number: | 1144265398 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED |
License Number: | 298 |
Business Practice Address: | 89 Reservoir Norris, TN - 378280567 |
Business Phone Number: | 8655487474 |
Business Fax Number: | |
Mailing Address: | Po Box 567, NORRIS |
State: | TN |
Postal Code: | 378280567 |
Phone Number: | 8655487474 |
Fax Number: | |
NPI Enumeration Date: | 06/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 298 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |