=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376200600
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CENTER FOR MINDFUL HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2021
-----------------------------------------------------
Last Update Date | 11/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7509 CANTRELL RD STE 217
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72207-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-626-8606
-----------------------------------------------------
Fax | 501-424-5399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10614 YOSEMITE VALLEY DR
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72212-3657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-626-8606
-----------------------------------------------------
Fax | 501-424-5399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CERTIFIED SOCIAL WORKER
-----------------------------------------------------
Name | KIM ALLEN JONES
-----------------------------------------------------
Credential | PH.D., LCSW
-----------------------------------------------------
Telephone | 501-626-8606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------