Tonya Denise Gordon
Individual provider Active NPI Case Manager/Care Coordinator · Lake Providence, LA
NPI 1346698792 · NPPES record last updated May 31, 2018
Key facts
- NPI
- 1346698792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Case Manager/Care Coordinator 171M00000X
- Practice address
- 1700 Lake St
Lake Providence, LA 71254 - Phone
- (318) 559-0551
- Fax
- (318) 559-0538
- NPI assigned
- May 26, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cognitive Development Center, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | Yes |
Addresses
Primary practice location
1700 Lake St
Lake Providence, LA 71254
Mailing address
1700 Lake St
Lake Providence, LA 71254-5208
Phone (318) 559-0551
Other practice location 1
1705 Felicia Ave
Tallulah, LA 71282-8203
Phone (318) 574-1232
Other providers in Lake Providence, LA
- Fred'S Pharmacy #3958
- Freds Stores of Tennessee Inc.
- Catina Freeman
- Heather George
- Sharolyn Gibson
- H & H Transportation LLC
- Stacey Hackler
- Amy Garrett Hale
- Kaleisha Hanford
- Pamela Renee Harvey
All providers in Lake Providence, LA · Case Manager/Care Coordinator in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.