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THEODORE GONGOLA
NPI 1053656108
Counselor in Russellville, AR

Active since November 30, 2012
3205 W MAIN ST, RUSSELLVILLE, AR 72801(479) 967-4673(479) 967-7140 Get Directions Write a Review

NPPES record last updated: November 30, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Theodore Gongola NPPES

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

THEODORE GONGOLA (NPI 1053656108) is an individual counselor in Russellville, Arkansas and active in the NPI registry since November 2012.

NPPES Registry Identity

NPI1053656108
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameTHEODORE GONGOLA
Location Address3205 W MAIN STRussellville, AR 72801-2301
Mailing Address602 N Walton BlvdBentonville, AR 72712-4576 · (479) 464-1060 · Fax (479) 271-6307
Phone(479) 967-4673
Fax(479) 967-7140
Sole ProprietorNo
Enumeration DateNovember 30, 2012
✔ NPI 1053656108 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
3205 W MAIN ST, Russellville, AR 72801
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Other Providers at the Same Location NPPES 20

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

JAROD LOUIS UNDERWOOD
Behavior Technician
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 567-5470
RHONDA WILLIAMS
Counselor
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 967-4673
ALISHA GAIL DELATORRE
Counselor
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 967-4673
BETH N ONASCH
Counselor
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 967-4673
BREANNA CURTIS
Behavior Technician
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 567-5470
PRESCRIPTIVE NUTRITION, LLC
Nutritionist
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 651-8547
RENA TAYLOR
Clinic/Center (Adult Day Care)
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 280-1914
JASMIN HERNANDEZ
Behavior Technician
3205 W MAIN ST
RUSSELLVILLE, AR 72801
Pope County (479) 567-5470

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Gongola's NPI number?

The NPI number for Theodore Gongola is 1053656108. It was assigned to this individual provider in the NPPES registry on November 30, 2012.

Where is Theodore Gongola located?

Theodore Gongola practices at 3205 W Main St, Russellville, AR 72801. The listed phone number is (479) 967-4673.

What is Theodore Gongola's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Theodore Gongola was last updated on November 30, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.