Healthcare Provider Details

I. General information

NPI: 1336271659
Provider Name (Legal Business Name): ASCENT ACQUISITIONS CORP-PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2653
US

IV. Provider business mailing address

3012 TURMAN DR
JONESBORO AR
72404-8998
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-2220
  • Fax: 501-955-5531
Mailing address:
  • Phone: 870-819-0200
  • Fax: 870-819-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: HOLLY ALLGOOD
Title or Position: BILLING SPECIALIST
Credential:
Phone: 870-819-0232