1477704898 NPI number — COUNSELING SERVICES OF EASTERN ARKANSAS

Table of content: (NPI 1477704898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477704898 NPI number — COUNSELING SERVICES OF EASTERN ARKANSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING SERVICES OF EASTERN ARKANSAS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477704898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2707 BROWNS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-7213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-972-4939
Provider Business Mailing Address Fax Number:
870-972-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 MISSOURI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72342-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-338-3434
Provider Business Practice Location Address Fax Number:
870-972-4911
Provider Enumeration Date:
10/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYERLY
Authorized Official First Name:
DONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER CREDENTIALING
Authorized Official Telephone Number:
870-972-4939

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172035526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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