Provider Demographics
NPI:1558694802
Name:DAILY BREAD COUNSELING
Entity Type:Organization
Organization Name:DAILY BREAD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:TEETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-847-2229
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72089-0298
Mailing Address - Country:US
Mailing Address - Phone:501-847-2229
Mailing Address - Fax:501-847-8608
Practice Address - Street 1:200 N MARKET ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3733
Practice Address - Country:US
Practice Address - Phone:501-847-2229
Practice Address - Fax:501-847-8608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9903009101YM0800X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142495019Medicaid