Viola M Statham Gordon, MA, PE, LPCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1046

Practice address

322 Frontier Blvd
Stanford, KY 40484-7730

Phone

(859) 253-1686

Fax

(859) 254-2743

NPI assigned

Feb 8, 2007

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 identifiers 1

Other names 1

• Viola M Statham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1257811200000",
    "number": "1508906207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 NEWTOWN PIKE",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405111217",
            "telephone_number": "859-253-1686",
            "fax_number": "859-254-2743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 FRONTIER BLVD",
            "city": "STANFORD",
            "state": "KY",
            "postal_code": "404847730",
            "telephone_number": "859-253-1686",
            "fax_number": "859-254-2743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHAM GORDON",
        "first_name": "VIOLA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "MA, PE, LPCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2009-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": "1046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30615058",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIOLA",
            "last_name": "STATHAM",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Stanford, KY
• Providers in Stanford, KY by specialty
• Professional Counselor in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2009; 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.