Travis Gordon

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6451017462 Issued in MI

Practice address

4867 E Beltline Ave NE
Building #1, Suite 4
Grand Rapids, MI 49525

Phone

(616) 232-6050

NPI assigned

Jul 1, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 19, 2024 through Dec 19, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Retreat Counseling LLC

  • Mental Health Counselor
  • Grand Rapids, MI
  • NPI 1710615794
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1104488105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E BELTLINE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495255803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4867 E BELTLINE AVE NE",
            "address_2": "BUILDING #1, SUITE 4",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-232-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "TRAVIS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-01",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6451017462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "travis@retreatcounseling.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4867 E Beltline Ave NE",
            "address_2": "Building #1, Suite 4",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Timothy Mark Goralski, PA
• Joanne Gorant, PH.D.
• Anne Elisa Gordon, PA-C
• Annelise R Gordon
• Emily Gordon
• Artemio Jr Gordonas, LPTA, AAS, MS, BS
• Thomas W Gore, MD
• Sharla Goree
• Allison Gorine
• David Gorman

• Professional Counselor in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Professional Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.