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General NPI Number Information
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NPI Number | 1023496262
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Entity Type | Organization
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Legal Business Name | INHOPE COUNSELING SERVICES COMPANY
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 04/20/2024
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Provider Practice Location Address
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Address Line | 1305 E MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5322
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Country | US
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Telephone | 479-393-9866
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Fax | 479-358-1464
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Provider Business Mailing Address
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Address Line | 1305 EAST MAIN STREET
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5322
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Country | US
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Telephone | 479-393-9866
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Fax | 479-358-1464
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Authorized Official
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Title or Position | DOCTOR OF PSYCHOTHERAPY
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Name | DR. KAREN S GONGOLA
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Credential | PHD, LPC
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Telephone | 479-393-9866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0512076
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License Number State | AR
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