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General NPI Number Information
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NPI Number | 1417126582
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Entity Type | Organization
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Legal Business Name | CHILDREN'S EVALUATION &COUNSELING CENTER LLC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 212 W. SEVIER
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-776-7708
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2346
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City | BENTON
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State | AR
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Zip | 72018-2346
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Country | US
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Telephone | 501-776-7708
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Fax |
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Authorized Official
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Title or Position | LICENSED INDEPENDENT PSYCHOLOGICAL
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Name | MS. MARY ANN CALLISON
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Credential | LPE-I
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Telephone | 501-776-7708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 92-05 LPE-I
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License Number State | AR
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