Provider Demographics
NPI:1871136267
Name:GORDON, MICHAEL DESHUAN (LPC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DESHUAN
Last Name:GORDON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SPANISH MOSS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5838
Mailing Address - Country:US
Mailing Address - Phone:601-376-6222
Mailing Address - Fax:
Practice Address - Street 1:112 SPANISH MOSS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5838
Practice Address - Country:US
Practice Address - Phone:601-376-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSNONEOtherNONE