Basic Information
| Provider Information | |||||||||
| NPI: | 1881797793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GHORMLEY | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | LOU | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S. 48TH STREET | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 76762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797502020 | ||||||||
| FaxNumber: | 4797508967 | ||||||||
| Practice Location | |||||||||
| Address1: | 827 W HARVARD ST | ||||||||
| Address2: | |||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727614013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795493121 | ||||||||
| FaxNumber: | 4797504843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | P0708039 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 911302980 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | P0708039 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.