Basic Information
| Provider Information | |||||||||
| NPI: | 1124281209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONNOR | ||||||||
| FirstName: | WINONA | ||||||||
| MiddleName: | GAYLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 W GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719013931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016233700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAMAR | ||||||||
| State: | AR | ||||||||
| PostalCode: | 728467401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797330400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2052-C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 5EC12 | 01 | AR | BCBS | OTHER | 14189573 | 01 | AR | CAQH | OTHER | 236859719 | 05 | AR | MEDICAID |