Provider Demographics
NPI:1609324128
Name:GORDEYEV, VLADIMIR ALEKSANDROVICH (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:ALEKSANDROVICH
Last Name:GORDEYEV
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 42ND ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2701
Mailing Address - Country:US
Mailing Address - Phone:515-255-8399
Mailing Address - Fax:
Practice Address - Street 1:7401 METRO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3062
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:612-268-5868
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082182101YM0800X
MN4425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469676Medicaid
MN4425OtherSTATE LICENSE
558566OtherMEDICAID