Paola Karla Gordillo, LPC, LCDC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

85816 Issued in TX

Practice address

3200 Sanguinet St
Fort Worth, TX 76107-5355

Phone

(817) 255-2652

Fax

(817) 255-2657

NPI assigned

Aug 22, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Paola Gonzalez-Frayre Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Lena Pope Home, Inc.

  • Professional Counselor
  • Fort Worth, TX
  • NPI 1093856924
  Medicare reassignment NPD

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

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1396529236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 SANGUINET ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075355",
            "telephone_number": "817-255-2652",
            "fax_number": "817-255-2657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SANGUINET ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761075355",
            "telephone_number": "817-255-2652",
            "fax_number": "817-255-2657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDILLO",
        "first_name": "PAOLA",
        "middle_name": "KARLA",
        "credential": "LPC, LCDC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "85816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAOLA",
            "last_name": "GONZALEZ-FRAYRE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mallory Nicole Goodwin, LPC
• Abbey Goodyear, MD
• Lauren Alexandra Goolsbay, D.O.
• Sarah Elaine Goolsbee, DPT
• Belinda Grace Gopito
• Gordon G. McWatt, D.O., P.a.
• Matthew James Gordon-Short, DO
• Amber Gordon, LCSW
• Kimberly L Gordon, MD
• Kooper Gordon, LCSW

• Professional Counselor in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.