Basic Information
| Provider Information | |||||||||
| NPI: | 1316924137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLADDEN | ||||||||
| FirstName: | JORJA | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 125 DONS WAY | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016205130 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 DONS WAY | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016247111 | ||||||||
| FaxNumber: | 5016205109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 12/19/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0305020 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 71-0401764 | 01 | AR | CORPHEALTH | OTHER | 710401764GLA | 01 | AR | UNITY MANAGED MH CO. | OTHER | 116399726 | 05 | AR | MEDICAID | 230308 | 01 | AR | COMPSYCH | OTHER | 5X370 | 01 | AR | BLUE CROSS & BLUE SHIELD | OTHER | 926010 | 01 | AR | USA MANAGED CARE | OTHER | 244949 | 01 | AR | MHN NETWORK | OTHER | 1316924137 | 01 | AR | NOVA SYSTEM | OTHER | 1316924137 | 01 | AR | TRICARE | OTHER | 2187549 | 01 | AR | CIGNA BEHAVIORAL HEALTH | OTHER | 576115 | 01 | AR | VALUE OPTIONS | OTHER | MIS 718462000 | 01 | AR | MAGELLAN | OTHER | 3090013600 | 01 | AR | QUAL-CHOICE | OTHER | 60054 | 01 | AR | AETNA | OTHER | 710401764 | 01 | AR | MHNET | OTHER |