=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659439248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY COUNSELING & RECOVERY CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7509 CANTRELL RD STE 213
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72207-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-663-3260
-----------------------------------------------------
Fax | 501-663-6080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7509 CANTRELL RD STE 213
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72207-2529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-663-3260
-----------------------------------------------------
Fax | 501-663-6080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ROBERT BEN ALLEN JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-663-3260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------