Provider Demographics
NPI:1730917501
Name:GORDON, MILES (MFT-I)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:GORDON
Suffix:
Gender:M
Credentials:MFT-I
Other - Prefix:
Other - First Name:MILES
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8121 RUSSELL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7010
Mailing Address - Country:US
Mailing Address - Phone:970-331-3034
Mailing Address - Fax:
Practice Address - Street 1:6730 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5396
Practice Address - Country:US
Practice Address - Phone:702-665-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty