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General NPI Number Information
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NPI Number | 1427481282
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Entity Type | Organization
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Legal Business Name | HILLCREST CLINIC, INC.
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 3000 KAVANAUGH BLVD STE 209A
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3769
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Country | US
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Telephone | 501-680-4239
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 PINE VALLEY RD
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City | LITTLE ROCK
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State | AR
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Zip | 72207-1817
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Country | US
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Telephone | 501-680-4239
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC I PHELPS
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Credential | PHD, LCSW
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Telephone | 501-680-4239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2293-C
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License Number State | AR
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