Active NPI
Sophia Camille Gordon
- Mental Health Counselor
- Tulsa, OK
National Provider Identifier
1609210459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 11428 E 20TH St Ste a
Tulsa, OK 74128-6452 - Phone
- (918) 878-7877
- NPI assigned
- Apr 23, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
11428 E 20TH St Ste a
Tulsa, OK 74128-6452
Mailing address
9020 Cates Way
Oklahoma City, OK 73139-8518
Phone (405) 305-6559
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000000 | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366761600000",
"number": "1609210459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9020 CATES WAY",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731398518",
"telephone_number": "405-305-6559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11428 E 20TH ST STE A",
"city": "TULSA",
"state": "OK",
"postal_code": "741286452",
"telephone_number": "918-878-7877"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "SOPHIA",
"middle_name": "CAMILLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-04-23",
"last_updated": "2013-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000000000",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tulsa, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.