Active NPI
Sandra R Gordon, LPCC-SUPV
- Mental Health Counselor
- Pepper Pike, OH
National Provider Identifier
1891002721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- E.0500895-SUPV
- Practice address
- 3737 Lander Rd
Pepper Pike, OH 44124-5712 - Phone
- (216) 831-2255
- Fax
- (216) 378-3906
- NPI assigned
- Sep 14, 2010
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | E.0500895-SUPV | OH | Primary |
| Professional Counselor | 101YP2500X | E.0500895-SUPV | OH | |
| Professional Counselor | 101YP2500X | C.0500895 | OH | |
| Professional Counselor | 101YP2500X | E.0500895 | OH |
Addresses
Primary practice location
3737 Lander Rd
Pepper Pike, OH 44124-5712
Mailing address
3737 Lander Rd
Pepper Pike, OH 44124-5712
Phone (216) 831-2255
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0268768 | Medicaid | OH | |
| 2871101 | Medicaid | OH |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E.0500895-SUPV | OH | MD | Mental Health Counselor |
| C.0500895 | OH | MD | Professional Counselor |
| E.0500895 | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1891002721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3737 LANDER RD",
"city": "PEPPER PIKE",
"state": "OH",
"postal_code": "441245712",
"telephone_number": "216-831-2255",
"fax_number": "216-378-3906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3737 LANDER RD",
"city": "PEPPER PIKE",
"state": "OH",
"postal_code": "441245712",
"telephone_number": "216-831-2255",
"fax_number": "216-378-3906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORDON",
"first_name": "SANDRA",
"middle_name": "R",
"credential": "LPCC-SUPV",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-14",
"last_updated": "2016-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "OH",
"license": "E.0500895-SUPV",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.0500895-SUPV",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "C.0500895",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "E.0500895",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0268768",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2871101",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pepper Pike, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.