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General NPI Number Information
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NPI Number | 1669887808
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Entity Type | Organization
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Legal Business Name | COUNSELING AND ASSESSMENT CLINIC PLLC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 306 SALEM RD STE 109
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City | CONWAY
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State | AR
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Zip | 72034-6376
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Country | US
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Telephone | 501-428-7290
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Fax |
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Provider Business Mailing Address
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Address Line | 306 SALEM RD STE 109
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City | CONWAY
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State | AR
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Zip | 72034-6376
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Country | US
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Telephone | 501-428-7290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVID A RUBLE
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Credential | LPE-I
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Telephone | 501-428-7290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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License Number State | AR
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