Healthcare Provider Details

I. General information

NPI: 1003671777
Provider Name (Legal Business Name): MUMFORD AND ASSOCIATES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 JORDAN MNR
LITTLE ROCK AR
72204-7902
US

IV. Provider business mailing address

811 NORTH GRANT STREET SUITE 6
LITTLE ROCK AR
72205-7902
US

V. Phone/Fax

Practice location:
  • Phone: 501-229-9220
  • Fax:
Mailing address:
  • Phone: 501-229-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. QUINYATTA MUMFORD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: DRPH
Phone: 501-229-9220