Individual provider Active NPI

Denise Ann Gordon, LPC

  • Professional Counselor
  • Benton, AR
National Provider Identifier
1225284201
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
P1306069 Issued in AR
Practice address
110 Pearson
Benton, AR 72015-4436
Phone
(501) 315-4224
Fax
(501) 778-0450
NPI assigned
Aug 11, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X P1306069 AR Primary

Addresses

Primary practice location

110 Pearson
Benton, AR 72015-4436

Mailing address

110 Pearson
Benton, AR 72015-4436
Phone (501) 315-4224

Other names 1

  • Denise Ann Devasier Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240204000082 AR Practitioner - Mental Health Counselor 0749623098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Counseling Clinic IncGroup PAC ID 6204885304, 20 clinicians

Practice addresses (Care Compare)

110 Pearson
Benton, AR 72015-4436
Phone (501) 315-4224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P1306069ARMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling Clinic, Inc Current Accepting new patients
Counseling Clinic, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Living Hope Southeast, LLC PastSince Mar 1, 2008 Accepting new patients

Locations

110 Pearson
Benton, AR 72015
Phone (501) 315-4224

310 Whittington Ave
Hot Springs National Park, AR 71901
Phone (501) 623-3477

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/lhsoutheast/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1225284201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PEARSON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720154436",
            "telephone_number": "501-315-4224",
            "fax_number": "501-778-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "DENISE",
        "middle_name": "ANN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-11",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P1306069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DENISE",
            "last_name": "DEVASIER",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Benton, AR

Sources for this page

Verify at the official NPI Registry.