Healthcare Provider Details

I. General information

NPI: 1215955638
Provider Name (Legal Business Name): COUNSELING SERVICES OF JACKSONVILLE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S 1ST ST
JACKSONVILLE AR
72076
US

IV. Provider business mailing address

707 S 1ST ST
JACKSONVILLE AR
72076
US

V. Phone/Fax

Practice location:
  • Phone: 501-985-0292
  • Fax: 501-985-2070
Mailing address:
  • Phone: 501-985-0292
  • Fax: 501-985-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES RANDALL WALKER
Title or Position: OWNER CLINICAL DIRECTOR
Credential: PHD
Phone: 501-985-0292