Provider Demographics
NPI:1669547147
Name:GORE, BARBARA J (LCSW)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:GORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 665
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822
Mailing Address - Country:US
Mailing Address - Phone:870-898-4105
Mailing Address - Fax:
Practice Address - Street 1:451 W LOCKE ST
Practice Address - Street 2:SUITE B
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-3325
Practice Address - Country:US
Practice Address - Phone:870-898-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1254-C1041C0700X
TX257261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0067HNOtherBCBS
TX145878802Medicaid
TX257067OtherMHN
TX145878801Medicaid
TX613043Medicare UPIN
TX145878801Medicaid