Provider Demographics
NPI:1093361362
Name:GEROY, GREGORY NEIL (LMSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:NEIL
Last Name:GEROY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:NEIL
Other - Last Name:GEROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHPP, QBHP
Mailing Address - Street 1:1815 PLEASANT GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1507 E RACE STREET
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4661
Practice Address - Country:US
Practice Address - Phone:501-305-2359
Practice Address - Fax:501-305-2348
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10213-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171M00000XMedicaid