Healthcare Provider Details

I. General information

NPI: 1588932875
Provider Name (Legal Business Name): CORNERSTONE ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 COURT ST STE 1
CONWAY AR
72032-5417
US

IV. Provider business mailing address

611 COURT ST STE 1
CONWAY AR
72032-5417
US

V. Phone/Fax

Practice location:
  • Phone: 501-940-4435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-6895
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0618P
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number99-5E
License Number StateAR

VIII. Authorized Official

Name: SHELIA SMITH
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 501-730-3578