| Theodore Gongola, | |
|
3205 W Main St, Russellville, AR 72801-2301 | |
| (479) 967-4673 | |
| (479) 967-7140 |
| Full Name | Theodore Gongola |
|---|---|
| Gender | Male |
| Speciality | Counselor |
| Location | 3205 W Main St, Russellville, Arkansas |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053656108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore Gongola, 602 N Walton Blvd, Bentonville, AR 72712-4576 Ph: (479) 464-1060 | Theodore Gongola, 3205 W Main St, Russellville, AR 72801-2301 Ph: (479) 967-4673 |
Megan Roshawn Ford, Counselor Medicare: Not Enrolled in Medicare Practice Location: 110 Skyline Dr, Russellville, AR 72801 Phone: 479-967-5570 Fax: 479-890-5364 | |
Raven Cruz-humberto, Counselor Medicare: Not Enrolled in Medicare Practice Location: 700 E Parkway Dr, Russellville, AR 72801 Phone: 866-921-0149 Fax: 479-777-4400 | |
Phillip M Higdon, MS LADAC CCS Counselor Medicare: Not Enrolled in Medicare Practice Location: 110 Skyline Drive, Russellville, AR 72801 Phone: 479-968-1298 Fax: 479-968-6053 | |
Mary Conner, Counselor Medicare: Not Enrolled in Medicare Practice Location: 400 Lake Front Dr, Russellville, AR 72802 Phone: 479-567-4744 | |
Mrs. Marilyn Jean Mckown, MHPP Counselor Medicare: Not Enrolled in Medicare Practice Location: 1310 W Main St Ste 100, Russellville, AR 72801 Phone: 479-964-2011 | |
Matthew Waymack, Counselor Medicare: Not Enrolled in Medicare Practice Location: 1610 S Arkansas Ave, Russellville, AR 72801 Phone: 479-967-4673 Fax: 479-967-7140 |