Healthcare Provider Details

I. General information

NPI: 1184131252
Provider Name (Legal Business Name): LAUREL NICHOLE GASS PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E CRANDALL AVE
HARRISON AR
72601-3629
US

IV. Provider business mailing address

9921 COTTONWOOD
OMAHA AR
72662-8204
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8484
  • Fax:
Mailing address:
  • Phone: 870-204-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: