Basic Information
| Provider Information | |||||||||
| NPI: | 1851060701 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGORY | ||||||||
| FirstName: | EMILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 BRIDGES AVE E STE A | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723962343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706302328 | ||||||||
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| Practice Location | |||||||||
| Address1: | 613 RIGHTOR ST | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723423223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706302328 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 10/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A2210002 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | AR | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.