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General NPI Number Information
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NPI Number | 1821125055
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Entity Type | Organization
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Legal Business Name | THE NARROW GATE LLC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1008 W OHIO ST
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City | ROCKVILLE
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State | IN
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Zip | 47872-1536
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Country | US
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Telephone | 765-569-5350
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Fax | 765-569-5340
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Provider Business Mailing Address
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Address Line | 1008 W OHIO ST
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City | ROCKVILLE
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State | IN
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Zip | 47872-1536
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Country | US
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Telephone | 765-569-5350
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Fax | 765-569-5340
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Authorized Official
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Title or Position | PROVIDER/ADMIN/MEMBER
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Name | LINDA J HANNER
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Credential | PHD HSPP MAC
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Telephone | 765-569-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 20041104A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20041104A
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License Number State | IN
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