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General NPI Number Information
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NPI Number | 1215955638
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES OF JACKSONVILLE PA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 707 S 1ST ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076
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Country | US
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Telephone | 501-985-0292
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Fax | 501-985-2070
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Provider Business Mailing Address
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Address Line | 707 S 1ST ST
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City | JACKSONVILLE
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State | AR
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Zip | 72076
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Country | US
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Telephone | 501-985-0292
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Fax | 501-985-2070
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Authorized Official
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Title or Position | OWNER CLINICAL DIRECTOR
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Name | DR. JAMES RANDALL WALKER
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Credential | PHD
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Telephone | 501-985-0292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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