Healthcare Provider Details

I. General information

NPI: 1669649836
Provider Name (Legal Business Name): JAMES SKINNER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 WHITE DR
BATESVILLE AR
72501-9384
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 870-919-3381
  • Fax:
Mailing address:
  • Phone: 479-725-5115
  • Fax: 479-750-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7455-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: