Individual provider Active NPI

Gloria J Cunningham, LCSW

  • Clinical Social Worker
  • Hope, AR
National Provider Identifier
1275610024
Registry record updated Jun 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2416-C Issued in AR
Practice address
114 Medical Park Dr
Hope, AR 71801-8100
Phone
(870) 474-5001
Fax
(903) 791-9353
NPI assigned
Nov 1, 2006
Last updated
Jun 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2416-C AR Primary

Addresses

Primary practice location

114 Medical Park Dr
Hope, AR 71801-8100

Mailing address

PO Box 1326
Marshall, TX 75671-1326
Phone (903) 927-3782

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
I20110608000370 AR Practitioner - Clinical Social Worker 8426235029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

114 Medical Park Dr
Hope, AR 71801-8100
Phone (870) 474-5001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2416-CARMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Experience Counseling Clinic, Inc. CurrentSince May 22, 2023 Accepting new patients
TFS of Gurdon Inc Past Accepting new patients
Experience Counseling Clinic, Inc. Past Accepting new patients

Locations

114 Medical Park Dr
Hope, AR 71801
Phone (870) 474-5001

509 S Main St
Hope, AR 71801
Phone (870) 474-5001

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1275610024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1326",
            "city": "MARSHALL",
            "state": "TX",
            "postal_code": "756711326",
            "telephone_number": "903-927-3782",
            "fax_number": "903-927-1764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 MEDICAL PARK DR",
            "city": "HOPE",
            "state": "AR",
            "postal_code": "718018100",
            "telephone_number": "870-474-5001",
            "fax_number": "903-791-9353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "GLORIA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "2416-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hope, AR

Sources for this page

Verify at the official NPI Registry.