Healthcare Provider Details

I. General information

NPI: 1558694802
Provider Name (Legal Business Name): DAILY BREAD COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MARKET ST
BENTON AR
72015-3733
US

IV. Provider business mailing address

PO BOX 298
BRYANT AR
72089-0298
US

V. Phone/Fax

Practice location:
  • Phone: 501-847-2229
  • Fax: 501-847-8608
Mailing address:
  • Phone: 501-847-2229
  • Fax: 501-847-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberP9903009
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP9903009
License Number StateAR

VIII. Authorized Official

Name: MR. GARRY DEAN TEETER
Title or Position: OWNER
Credential: LPC
Phone: 501-847-2229