Provider Demographics
NPI:1821505017
Name:GATELY, AUDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:GATELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251420
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1420
Mailing Address - Country:US
Mailing Address - Phone:016-142-8105
Mailing Address - Fax:501-562-6562
Practice Address - Street 1:1210 WOLFE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-4618
Practice Address - Country:US
Practice Address - Phone:501-364-5150
Practice Address - Fax:501-603-1840
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8419-M104100000X
AR8419-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker