Healthcare Provider Details

I. General information

NPI: 1184757601
Provider Name (Legal Business Name): ASCENT ACQUISITIONS CORP-CYPDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GLENDALE ST
JONESBORO AR
72401-4455
US

IV. Provider business mailing address

3012 TURMAN DR
JONESBORO AR
72404-8998
US

V. Phone/Fax

Practice location:
  • Phone: 870-933-9528
  • Fax:
Mailing address:
  • Phone: 870-819-0200
  • Fax: 870-819-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: HOLLY ALLGOOD
Title or Position: BILLING SPECIALIST
Credential:
Phone: 870-819-0232