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General NPI Number Information
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NPI Number | 1003234675
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Entity Type | Organization
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Legal Business Name | JILL GORMAN LPC LLC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 1501 N UNIVERSITY AVE STE 700
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5297
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Country | US
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Telephone | 817-681-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 16 WOODBERRY RD
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City | LITTLE ROCK
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State | AR
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Zip | 72212-2742
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Country | US
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Telephone | 817-681-0069
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JILL GORMAN
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Credential | LPC
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Telephone | 817-681-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1212118
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License Number State | AR
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