Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kenric Glenn Gordon, LMSW

Individual provider Social Worker · NPI 1114540804

Kenric Glenn Gordon, LMSW is a Clinical Social Worker in Chubbuck, Idaho. Qualified in 2021, 5 years ago. Practices with Mental Health Specialists, an 11-clinician group and offers telehealth. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2020
What do these letters mean?
LMSW — Licensed Master Social Worker
A master's-level social worker, usually practising under supervision.

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Practice location Address checks out

210 W Burnside Ave Ste A
Chubbuck, ID 83202-4916
Phone: (208) 238-9000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Social Worker (primary) Taxonomy 104100000X · Licence LMSW-39661 (ID)

Record details

NPI number1114540804
Entity typeIndividual (Type 1)
GenderMale
Credentials LMSW
Sole proprietorNo
NPI enumeratedMay 28, 2020
Last updated in NPPESMay 28, 2020
Certification dateMay 28, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Mental Health Specialists — 11 clinicians
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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