Healthcare Provider Details

I. General information

NPI: 1407420722
Provider Name (Legal Business Name): NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 DAVID ST
CORNING AR
72422-7268
US

IV. Provider business mailing address

2707 BROWNS LN
JONESBORO AR
72401-7213
US

V. Phone/Fax

Practice location:
  • Phone: 870-857-3655
  • Fax:
Mailing address:
  • Phone: 870-972-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLA PRATT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 870-972-4016