Provider Demographics
NPI:1740625177
Name:GILCHRIST PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:GILCHRIST PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-934-8127
Mailing Address - Street 1:522 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2780
Mailing Address - Country:US
Mailing Address - Phone:870-934-8127
Mailing Address - Fax:870-933-8919
Practice Address - Street 1:522 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2780
Practice Address - Country:US
Practice Address - Phone:870-934-8127
Practice Address - Fax:870-933-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty