Healthcare Provider Details

I. General information

NPI: 1245034693
Provider Name (Legal Business Name): CIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W CENTER ST
FAYETTEVILLE AR
72701-5934
US

IV. Provider business mailing address

300 W 24TH ST
FAYETTEVILLE AR
72701-6979
US

V. Phone/Fax

Practice location:
  • Phone: 479-459-7341
  • Fax:
Mailing address:
  • Phone: 479-459-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA L NALLY
Title or Position: OWNER
Credential: LCSW
Phone: 479-459-7341