Maria Jose Gomez Bustillo

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A2308013 Issued in AR

Practice address

10311 W Markham St
Little Rock, AR 72205-2135

Phone

(501) 781-2230

NPI assigned

Aug 22, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chenal Family Therapy, PLC

  • Mental Health Counselor
  • Little Rock, AR
  • NPI 1356604219
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1033993977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3321 S BOWMAN RD APT 123",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114687",
            "telephone_number": "501-258-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10311 W MARKHAM ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722052135",
            "telephone_number": "501-781-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMEZ BUSTILLO",
        "first_name": "MARIA JOSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-08-22",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": "A2308013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ora Goldsberry-Williams
• Leah Miriam Goldsholl, LMSW
• Sara R. Goldsholl, MD
• Shanterria Golette
• Brandon Golsberry
• Imani Geneva Gomez
• Reyna Gomez
• Twymenia Gomez, RN
• Sabrina Gonzales, OTD, OTR/L
• Taylor Nicole Gonzales, BS

• Mental Health Counselor in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Mental Health Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.