Provider Demographics
NPI:1821125055
Name:NARROW GATE LLC
Entity Type:Organization
Organization Name:NARROW GATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER, ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HANNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:765-569-5350
Mailing Address - Street 1:1008 W OHIO ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-1536
Mailing Address - Country:US
Mailing Address - Phone:765-569-5350
Mailing Address - Fax:765-569-5340
Practice Address - Street 1:1008 W OHIO ST
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47872-1536
Practice Address - Country:US
Practice Address - Phone:765-569-5350
Practice Address - Fax:765-569-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041104A103T00000X, 103TA0400X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224190OtherPTAN
IN200904480AMedicaid
IN200904480AMedicaid