Provider Demographics
NPI:1013505973
Name:GESTALT THERAPY PLLC
Entity Type:Organization
Organization Name:GESTALT THERAPY PLLC
Other - Org Name:GESTALT THERAPY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT-HEINZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:509-242-7274
Mailing Address - Street 1:2176 PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-8244
Mailing Address - Country:US
Mailing Address - Phone:509-242-7274
Mailing Address - Fax:
Practice Address - Street 1:2176 PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-8244
Practice Address - Country:US
Practice Address - Phone:509-242-7274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty