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General NPI Number Information
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NPI Number | 1881138550
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Entity Type | Individual
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Provider Name | SHANNON GACHOT-RIDGLEY LAC
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Gender | Female
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 205 SOUTH STREET SUITE 3
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-575-3261
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Fax | 501-778-5049
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Provider Business Mailing Address
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Address Line | 3517 STIVERS BLVD
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City | BRYANT
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State | AR
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Zip | 72022-9019
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Country | US
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Telephone | 501-326-7955
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Fax | 501-778-5049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A1808110
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2007049
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License Number State | AR
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