Gordon Lewis Bordeaux

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CP00003406 Issued in WA

Practice address

1007 Koala Ave
Omak, WA 98841-9247

Phone

(509) 826-6191

Fax

(509) 826-8416

NPI assigned

Mar 5, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Okanogan Behavioral Healthcare

  • Mental Health Counselor
  • Omak, WA
  • NPI 1154324929

  Addiction (Substance Use Disorder)

  NPD (past)
• Okanogan Behavioral Healthcare

  • Community/Behavioral Health Agency
  • Omak, WA
  • NPI 1366794034
  NPD (past)
• Mindcare Solutions of Texas PA

  • Psychiatry Physician
  • Austin, TX
  • NPI 1396290730
  NPD (past)

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

{
    "created_epoch": "1204675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204675200000",
    "number": "1285804328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 KOALA DRIVE",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "98841",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 KOALA AVE",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419247",
            "telephone_number": "509-826-6191",
            "fax_number": "509-826-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEAUX",
        "first_name": "GORDON",
        "middle_name": "LEWIS",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-05",
        "last_updated": "2008-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00003406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Anne Black, RDH
• Blackburn and Goodheart
• Debra Blair
• Alissa Maureen Blakley, RD
• Brian Scott Bonewell, CNP
• Michael D Bordner, MD
• Stephen K Both Jr., CRNA
• Tina Boyd
• Lena Lorraine Boyle, LICSW
• David A Bradford, MD

• All providers in Omak, WA
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.