Basic Information
| Provider Information | |||||||||
| NPI: | 1639458060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORE | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 299 | ||||||||
| Address2: | |||||||||
| City: | HOXIE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724330299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708861333 | ||||||||
| FaxNumber: | 8708861334 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 E 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | AR | ||||||||
| PostalCode: | 726534423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707015141 | ||||||||
| FaxNumber: | 8707015177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 09/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | AR | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 6603C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 183116795 | 05 | AR | MEDICAID |