Healthcare Provider Details

I. General information

NPI: 1790614063
Provider Name (Legal Business Name): ELI CRANFORD LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 W MARKHAM ST STE 300
LITTLE ROCK AR
72205-1583
US

IV. Provider business mailing address

10421 W MARKHAM ST STE 300
LITTLE ROCK AR
72205-1583
US

V. Phone/Fax

Practice location:
  • Phone: 501-603-2147
  • Fax: 501-603-0324
Mailing address:
  • Phone: 501-603-2147
  • Fax: 501-603-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2605004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: