Jennifer Gillis

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A1710300 Issued in AR

Practice address

200 NW 4TH St
Bryant, AR 72022

Phone

(501) 653-5061

NPI assigned

Apr 15, 2016

Last updated

Aug 23, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Napa Valley Counseling Center

  • Professional Counselor
  • Little Rock, AR
  • NPI 1427106707
  NPD (past)

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

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1861846974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15401 CHENAL PKWY APT 3208",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112566",
            "telephone_number": "501-428-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NW 4TH ST",
            "city": "BRYANT",
            "state": "AR",
            "postal_code": "72022",
            "telephone_number": "501-653-5061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 W Walnut St",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727563521",
            "country_code": "US",
            "telephone_number": "479-631-9996",
            "fax_number": "479-631-1782",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 W Walnut St",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727563521",
            "country_code": "US",
            "telephone_number": "479-631-9996",
            "fax_number": "479-631-1782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILLIS",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "A1710300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annie Beth George, SLP-CCC
• Shiela Gerasimenko, PT DPT
• Hali Brooke Gibson, LPC
• Camille Gill, CNP
• Tytaiona Gilliam
• Brooke Lynn Gipson, PHARMD
• David Bryon Glenn, O.D.
• Christina Godfrey, MHPP
• Gina Carroll Golden, SLP
• Bridget Nicole Gooden

• Professional Counselor in Bryant, AR
• Providers in Bryant, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.