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General NPI Number Information
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NPI Number | 1356855324
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Entity Type | Organization
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Legal Business Name | CIVILPSYCH, LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 484 COUNTY ROAD 7593
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City | JONESBORO
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State | AR
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Zip | 72401-7764
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Country | US
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Telephone | 870-932-4744
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Fax | 925-955-4744
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Provider Business Mailing Address
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Address Line | 484 COUNTY ROAD 7593
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City | JONESBORO
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State | AR
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Zip | 72401-7764
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Country | US
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Telephone | 870-932-4744
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Fax | 925-955-4744
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Authorized Official
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Title or Position | MEMBER
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Name | ROBERT HEATH MEEKS
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Credential | LCSW, NBCFCH, SAP
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Telephone | 870-932-4744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1870-C
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1870-C
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1870-C
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1870-C
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1870-C
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License Number State | AR
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1870-C
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License Number State | AR
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