Provider Demographics
NPI:1740038538
Name:BINGHAM, JENNA (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HARB ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-2507
Mailing Address - Country:US
Mailing Address - Phone:870-323-1772
Mailing Address - Fax:
Practice Address - Street 1:1301 HARB ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:AR
Practice Address - Zip Code:72422-2507
Practice Address - Country:US
Practice Address - Phone:870-323-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX638581041C0700X
AR22749-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical