NPIMap

Organization Active NPI

Gateway Family Therapy Services PLLC

  • Clinical Social Worker
  • Benton, AR
National Provider Identifier
1801406145
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
GATEWAY FAMILY THERAPY SERVICES PLLC
Practice address
400 Edison
Benton, AR 72015-5359
Phone
(501) 425-6476
Fax
(501) 358-3095
NPI assigned
Aug 2, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

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

Authorized official

Name
Laquita Shana WillisNPI 1497041321
Title
Ceo
Phone
(501) 425-6476

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

400 Edison
Benton, AR 72015-5359

Mailing address

400 Edison
Benton, AR 72015-5359
Phone (501) 425-6476

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250916000048 AR Part B Supplier - Clinic/Group Practice 0446754378 Receives reassigned benefits from 2 practitioners
Practice locations: Benton, AR

National Provider Directory

National Provider Directory

Locations

400 Edison
Benton, AR 72015
Phone (501) 425-6476

1920 Congo Rd
Ste C
Benton, AR 72015
Phone (501) 425-6476

1920 Congo Rd
Ste A
Benton, AR 72015
Phone (501) 425-6476

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1596326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783382400000",
    "number": "1801406145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EDISON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720155359",
            "telephone_number": "501-425-6476",
            "fax_number": "501-358-3095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 EDISON",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720155359",
            "telephone_number": "501-425-6476",
            "fax_number": "501-358-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY FAMILY THERAPY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-02",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "LAQUITA",
        "authorized_official_middle_name": "SHANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "501-425-6476"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.