Provider Demographics
NPI:1063217719
Name:GOUVEIA, ANNA (LAC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GOUVEIA
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13275 DICKSON RD
Mailing Address - Street 2:
Mailing Address - City:HIWASSE
Mailing Address - State:AR
Mailing Address - Zip Code:72739-6047
Mailing Address - Country:US
Mailing Address - Phone:479-903-3871
Mailing Address - Fax:
Practice Address - Street 1:305 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7840
Practice Address - Country:US
Practice Address - Phone:479-319-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2403017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health