TITO TERRELL GORDON LPC
NPI 1366193609
Counselor - Professional in Augusta, GA

Q: What is Tito Gordon's NPI number?

The NPI number for Tito Gordon is 1366193609. It was assigned to this individual provider in the NPPES registry on January 18, 2022. The provider is also known as Oto Terrell Gordon Apc.

Q: What is Tito Gordon's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Tito Gordon was last updated on May 27, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since January 18, 2022PECOS Enrolled

3633 WHEELER RD STE 365, AUGUSTA, GA 30909(706) 432-6866 Get Directions Write a Review

NPPES record last updated: May 27, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 27, 2026, Apr 24, 2026, Jan 18, 2022 (3 updates tracked since 2022).

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About Tito Terrell Gordon Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TITO TERRELL GORDON LPC (NPI 1366193609) is an individual professional provider in Augusta, Georgia, licensed in Georgia (LPC016394) and active in the NPI registry since January 2022. He is enrolled in Medicare PECOS, maintains a secondary practice location in Augusta, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1366193609

Entity TypeIndividualMale

Primary Taxonomy101YP2500X

Provider Legal NameTITO TERRELL GORDONCredential: LPC

Location Address3633 WHEELER RD STE 365Augusta, GA 30909-6549

Mailing Address4800 N Scottsdale Rd Ste 2500Scottsdale, AZ 85251-7630

Phone(706) 432-6866

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateJanuary 18, 2022

Last NPPES UpdateMay 27, 20263 updates tracked since enumeration

NPPES CertifiedMay 27, 2026

✔ NPI 1366193609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in GA · LPC016394

3633 WHEELER RD STE 365, Augusta, GA 30909

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Other Names 1

Former Name (1)Oto Terrell Gordon Apc

Secondary Practice Location 1

Location 13643 Walton Way Ext Bldg 4Augusta, GA 30909-6677 · Phone (706) 364-1404

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tito Terrell Gordon Lpc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID2567933575

PECOS Enrollment IDI20260609004780

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 18

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MICHELE DUPUIS BOUCHARD LPC

Counselor (Professional)