Healthcare Provider Details

I. General information

NPI: 1508471509
Provider Name (Legal Business Name): ACCESS COUNSELING & ASSESSMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 AMITY RD STE 604
CONWAY AR
72032-5993
US

IV. Provider business mailing address

505 AMITY RD STE 604
CONWAY AR
72032-5993
US

V. Phone/Fax

Practice location:
  • Phone: 501-825-3100
  • Fax:
Mailing address:
  • Phone: 501-825-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAVID A RUBLE
Title or Position: OWNER
Credential:
Phone: 501-339-4155