Basic Information
| Provider Information | |||||||||
| NPI: | 1023104338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HIGDON | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MS LADAC CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 SALEM ROAD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013368300 | ||||||||
| FaxNumber: | 5013293572 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 SKYLINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799681298 | ||||||||
| FaxNumber: | 4799686053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0245L | AR | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 7828E | AR | X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.