Krissa Gordon, CRC, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A2201013 Issued in AR

Practice address

17371 N Highway 71
Mountainburg, AR 72946-3615

Phone

(479) 790-3915

NPI assigned

Nov 8, 2022

Last updated

Nov 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• United Methodist Behavioral Health System, Inc

  • Adolescent and Children Mental Health Clinic/Center
  • Fayetteville, AR
  • NPI 1417111048
  NPD (past)

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667865600000",
    "number": "1669180873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 ALDERSGATE RD STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722056676",
            "telephone_number": "501-661-0720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17371 N HIGHWAY 71",
            "city": "MOUNTAINBURG",
            "state": "AR",
            "postal_code": "729463615",
            "telephone_number": "479-790-3915"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 W Sunbridge Dr",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727031822",
            "country_code": "US",
            "telephone_number": "479-582-5565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Viney Grove Rd",
            "address_purpose": "LOCATION",
            "city": "Prairie Grove",
            "state": "AR",
            "postal_code": "727532623",
            "country_code": "US",
            "telephone_number": "479-582-5565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GORDON",
        "first_name": "KRISSA",
        "credential": "CRC, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2201013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arkansas Rural Kare, Inc. (Mountainburg Family Clinic)
• Courtney Bogan
• Elisabeth Bostian-Neal, LCSW
• Janet Elizabeth Guyer, M.D.
• Tammy Hamilton, MS,RD,LD
• Sydney Leann Hockaday, MASSAGE THERAPIST
• Raegan Lea Huffor
• Mountainburg Operations, LLC (Cornerstone Therapeutic Community of Mountainburg)

• Mental Health Counselor in Mountainburg, AR
• Providers in Mountainburg, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.