Individual
MICHAEL HAYES GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
321 W PROMENADE ST, MEXICO, MO 65265-2719
(573) 582-1234
(573) 582-1212
Mailing address
321 W PROMENADE ST, MEXICO, MO 65265-2719
(573) 582-1234
(573) 582-1212
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003058
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196615
BLUE SHIELD/BLUE CHOICE
MO
05
—
497286310
—
MO
01
—
695629
HEALTHLINK
MO
Enumeration date
05/04/2006
Last updated
10/15/2007
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