Healthcare Provider Details

I. General information

NPI: 1669254181
Provider Name (Legal Business Name): MACI SCUDDER THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2023
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N UNIVERSITY AVE STE 915
LITTLE ROCK AR
72207-5238
US

IV. Provider business mailing address

1501 N UNIVERSITY AVE STE 915
LITTLE ROCK AR
72207-5238
US

V. Phone/Fax

Practice location:
  • Phone: 501-492-6860
  • Fax: 501-406-3671
Mailing address:
  • Phone: 501-492-6860
  • Fax: 501-406-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MACI NICOLE SCUDDER
Title or Position: OWNER
Credential: LCSW
Phone: 501-492-6860