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NPI Code Detail

MEDICARE: MRS. GAYLA JEAN SPENCE LPC

MEDICARE:  MRS. GAYLA JEAN SPENCE  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorP0705026AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15A490OTHERARBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992902464
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GAYLA JEAN SPENCE LPC
Provider Business Mailing Address
First Line : 1815 PLEASANT GROVE RD
Second Line :
City : JONESBORO
State : AR
Zip : 72401-7870
Country : US
Telephone Number : 870-933-6886
Fax Number : 870-933-9395
Provider Business Practice Location Address
First Line : 2126 N 1ST ST STE F
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-2868
Country : US
Telephone Number : 501-982-5000
Fax Number : 501-982-5007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 05/22/2018

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Directions to “ MRS. GAYLA JEAN SPENCE LPC” Practice Location

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