Mia Emily Gordon, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P1508084 Issued in AR

Practice address

204 Executive CT Ste 301
Little Rock, AR 72205-4532

Phone

(501) 679-1469

NPI assigned

Jun 5, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

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.

• Rose Counseling and Consulting PLLC

  • Clinic/Center
  • Little Rock, AR
  • NPI 1629602008
  NPD Authorized official
• Lead Teach Mentor, LLC

  dba Thriveworks Conway

  • Professional Counselor
  • Conway, AR
  • NPI 1851702724
  NPD (past)
• Lead, Teach, Mentor LLC

  dba Thriveworks Conway

  • Community/Behavioral Health Agency
  • Conway, AR
  • NPI 1497167548
  NPD (past)

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

{
    "created_epoch": "1370390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1396183091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W CAPITOL AVE STE 1213",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722013405",
            "telephone_number": "501-679-1469",
            "fax_number": "201-581-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 EXECUTIVE CT STE 301",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722054532",
            "telephone_number": "501-679-1469"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "575 Club Ln Ste 103",
            "address_purpose": "LOCATION",
            "city": "Conway",
            "state": "AR",
            "postal_code": "720343680",
            "country_code": "US",
            "telephone_number": "501-404-9737",
            "fax_number": "617-379-0496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "MIA",
        "middle_name": "EMILY",
        "name_prefix": "Ms.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-05",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1508084",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A1305056",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Denise Gordon, PHARM.D., BCPS
• Eric Houston Gordon, MD
• Jaclyn Gordon, DO
• Katrena L Gordon, NP
• Kori Raymer Gordon
• Otis T Gordon, M.D.
• Andrea Leigh Gore
• Michalee Gore, CRNA
• Rhett Christopher Gore, D.C.
• Richard Lloyd Gore, D.D.S.

• Professional Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.