IndividualActive
Theodore Gongola
NPI 1053656108 · Counselor · Russellville, AR
Theodore Gongola is a Counselor provider in Russellville, AR (NPI 1053656108).
Provider details
- NPI number
- 1053656108
- Entity type
- Individual
- Primary specialty
- CounselorBehavioral Health & Social Service Providers
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Established profile(72/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
83% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3205 W Main St
Russellville, AR 72801-2301
Phone: (479) 967-4673
Fax: (479) 967-7140
Street-level locationGet directions
Mailing address
602 N Walton Blvd
Bentonville, AR 72712-4576
Registry dates
- Enumerated
- 2012-11-30
- Last updated
- 2012-11-30
Frequently asked questions
- What is Theodore Gongola's NPI number?
- Theodore Gongola's National Provider Identifier (NPI) is 1053656108, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What is Theodore Gongola's specialty?
- Theodore Gongola is listed in the NPPES registry with a primary specialty of Counselor (Behavioral Health & Social Service Providers).
- Where is Theodore Gongola located?
- Theodore Gongola's practice location on file with NPPES is 3205 W Main St, Russellville, AR 72801-2301.
- What is Theodore Gongola's phone number?
- The practice phone number listed in the NPPES registry for Theodore Gongola is (479) 967-4673.
- Is Theodore Gongola's NPI active?
- Yes — Theodore Gongola's NPI (1053656108) is active in the NPPES registry as of the last update on 2012-11-30.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.