Provider Demographics
NPI:1235806720
Name:GORDON, TONYA LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:GORDON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4225 FLEUR DR STE 208
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2325
Mailing Address - Country:US
Mailing Address - Phone:515-851-4913
Mailing Address - Fax:515-297-7551
Practice Address - Street 1:15848 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-8450
Practice Address - Country:US
Practice Address - Phone:515-344-7343
Practice Address - Fax:515-608-4692
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA108750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health