Healthcare Provider Details

I. General information

NPI: 1518970730
Provider Name (Legal Business Name): CHANCEY DALE PLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FRANKIE LN
WHITE HALL AR
71602-2685
US

IV. Provider business mailing address

109 FRANKIE LN
WHITE HALL AR
71602-2685
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-3588
  • Fax: 870-247-2072
Mailing address:
  • Phone: 870-247-3588
  • Fax: 870-247-2072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPLMSW
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: