Organization Name: | JILL GORMAN LPC LLC |
NPI Number: | 1003234675 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JILL GORMAN (PRESIDENT) |
Mailing Address: | 1501 N University Ave Ste 700 Little Rock |
State: | AR US |
Postal Code: | 722075297 |
Phone Number: | 8176810069 |
Fax Number: | |
NPI Enumeration Date: | 04/01/2014 |
NPI Last Update Date: | 05/12/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | P1212118 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |