Basic Information
| Provider Information | |||||||||
| NPI: | 1013168442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDSON MAYNARD | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DAVIDSON MAYNARD | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2707 BROWNS LN | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724017213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709724939 | ||||||||
| FaxNumber: | 8709724088 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 NEWMAN DR | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723428950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703383900 | ||||||||
| FaxNumber: | 8703387798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2008 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P1201005 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.