Provider Demographics
NPI:1215381082
Name:STINNETT, GORDON
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:STINNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7151
Mailing Address - Country:US
Mailing Address - Phone:270-570-1467
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST STE 406
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3174
Practice Address - Country:US
Practice Address - Phone:270-867-8761
Practice Address - Fax:270-826-8737
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166452101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health