1619947447 NPI number — MS. CATHERINE STALLARD LCSW

Table of content: MS. CATHERINE STALLARD LCSW (NPI 1619947447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619947447 NPI number — MS. CATHERINE STALLARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STALLARD
Provider First Name:
CATHERINE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1619947447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 E 35TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71854-2745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-330-4460
Provider Business Mailing Address Fax Number:
870-330-4460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 W COLLIN RAYE DR STE 103A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DE QUEEN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71832-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-330-4460
Provider Business Practice Location Address Fax Number:
870-330-4460
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  881-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3070014300 . This is a "QUAL-CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 946148 . This is a "USA MANAGED CARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 116399726 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 71-0401764 . This is a "CORPHEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 284616000 . This is a "MAGELLAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5S578 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1051639 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 184009 . This is a "VALUE OPTIONS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 184557 . This is a "COMPSYCH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 17650 . This is a "UNITED BEHAVIORAH HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 41017 . This is a "MHN NETWORK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 710401764STA . This is a "UNITY MANAGED M.H. CO." identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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