Basic Information
| Provider Information | |||||||||
| NPI: | 1528388253 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MID-SOUTH HEALTH SYSTEMS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2707 BROWNS LN | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724017213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709724939 | ||||||||
| FaxNumber: | 8709724911 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 ATKINS BLVD | ||||||||
| Address2: | |||||||||
| City: | MARIANNA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723602110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702954050 | ||||||||
| FaxNumber: | 8702954054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LYERLY | ||||||||
| AuthorizedOfficialFirstName: | DONNIE | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 8709724939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTHEAST ARKANSAS COMMUNITY MENTAL HEALTH CENTER INC | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.