Healthcare Provider Details

I. General information

NPI: 1386550531
Provider Name (Legal Business Name): INNER CIRCLE AUTISM NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 MARKET ST STE C125
LITTLE ROCK AR
72211-1979
US

IV. Provider business mailing address

3109 OZARK DR
BRYANT AR
72022-4081
US

V. Phone/Fax

Practice location:
  • Phone: 479-318-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JORDYN RENEE CASTON
Title or Position: RBT
Credential:
Phone: 773-815-1899