Provider Demographics
NPI:1215959192
Name:BATHEL, GORDON DEAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:GORDON
Middle Name:DEAN
Last Name:BATHEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 E PIMA ST STE 115
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3691
Mailing Address - Country:US
Mailing Address - Phone:520-275-6780
Mailing Address - Fax:520-795-3575
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:SUITE #140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-275-6780
Practice Address - Fax:520-795-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-0167101YA0400X
AZLCSW-09741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCSW9741Medicaid
AZ101349Medicare ID - Type Unspecified
AZCSW9741Medicaid