Healthcare Provider Details

I. General information

NPI: 1336266055
Provider Name (Legal Business Name): ERIC BASKINS LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5509 FOREST PLACE SUITE 100
LITTLE ROCK AR
72207
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-4949
  • Fax: 501-660-6840
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: