=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740291244
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD REES GAMBEL LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 FORT ROOTS DR. BLDG 170 RM 1L-153
-----------------------------------------------------
City | NORTH LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-257-3356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11073 BAINBRIDGE DR
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72212-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-221-1217
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 401-M
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------