Healthcare Provider Details

I. General information

NPI: 1093349995
Provider Name (Legal Business Name): GAP RELIEF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2020
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 SUNSET RIDGE CIR
SPRINGDALE AR
72762-8162
US

IV. Provider business mailing address

PO BOX 7708
SPRINGDALE AR
72766-7708
US

V. Phone/Fax

Practice location:
  • Phone: 479-595-2228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN TAYLOR
Title or Position: CO-DIRECTOR
Credential: MS, LPC, LMFT
Phone: 479-903-2478