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General NPI Number Information
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NPI Number | 1972163434
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Entity Type | Organization
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Legal Business Name | COLLECTIVE PLLC
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 10201 W MARKHAM ST STE 203
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2181
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Country | US
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Telephone | 501-424-0555
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Fax | 501-500-2666
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Provider Business Mailing Address
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Address Line | 10201 W MARKHAM ST STE 203
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2181
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Country | US
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Telephone | 501-424-0555
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Fax | 501-500-2666
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MS. RAYSHA K CLARK
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Credential | LPC
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Telephone | 501-424-0555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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