| Paula S. Gordy Lisw, Llc | |
|
501 N 12th St Ste 1 Centerville IA 52544-1439 | |
| (641) 856-2688 | |
| (641) 856-2690 |
| Full Name | Paula S. Gordy Lisw, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 501 N 12th St Ste 1, Centerville, Iowa |
| Authorized Official Name and Position | Paula Sue Gordy (OWNER) |
| Authorized Official Contact | 6418562688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paula S. Gordy Lisw, Llc 501 N 12th St Ste 1 Centerville IA 52544-1439 Ph: (641) 856-2688 | Paula S. Gordy Lisw, Llc 501 N 12th St Ste 1 Centerville IA 52544-1439 Ph: (641) 856-2688 |
| NPI Number | 1174858963 |
|---|---|
| Provider Enumeration Date | 10/12/2009 |
| Last Update Date | 05/06/2021 |
| Certification Date | 11/02/2020 |
| Medicare PECOS PAC ID | 3971644204 |
|---|---|
| Medicare Enrollment ID | O20100108000790 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174858963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 01294 (Iowa) | Primary |
| Provider Name | Paula S Gordy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912052325 PECOS PAC ID: 2264590074 Enrollment ID: I20081023000372 |
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