Basic Information
| Provider Information | |||||||||
| NPI: | 1528575511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRISP | ||||||||
| FirstName: | LINLEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 W GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719013931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016233700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 JEFFERSON ST SW | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 717013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708368888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2017 | ||||||||
| LastUpdateDate: | 02/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | A1708272 | AR | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 226688795 | 05 | AR | MEDICAID |