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NPI Code Detail

MEDICARE: NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC

MEDICARE: NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043461510
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
Provider Business Mailing Address
First Line : 2707 BROWNS LN
Second Line :
City : JONESBORO
State : AR
Zip : 72401-7213
Country : US
Telephone Number : 870-972-4000
Fax Number : 870-972-4968
Provider Business Practice Location Address
First Line : 209 S LOCKARD ST
Second Line :
City : BLYTHEVILLE
State : AR
Zip : 72315-2541
Country : US
Telephone Number : 870-763-2139
Fax Number : 870-972-4911
Authorized Official
Title or Position : OFFICE MANAGER
Name : CARLA JONES
Credential :
Telephone Number : 870-972-4900
Provider Enumeration Date : 10/02/2008
Last Update Date : 04/22/2022

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1336271741 — LARTYANIA MERRIWEATHER LMSW
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1659664886 — NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC
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1689920696 — LEIGHANNA M COLLINS
Practice Location Address:
209 S LOCKARD ST
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72315-2541
Practice Phone: 870-763-2139
Practice Fax: 870-763-5056

Directions to “NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC ” Practice Location

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