Basic Information
| Provider Information | |||||||||
| NPI: | 1598730566 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGREW | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | TENNILLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ED.D, LPC, NCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1308 E KIEHL AVE | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721203040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014876010 | ||||||||
| FaxNumber: | 5012027513 | ||||||||
| Practice Location | |||||||||
| Address1: | 1308 E KIEHL AVE | ||||||||
| Address2: | |||||||||
| City: | SHERWOOD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721203040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5014876010 | ||||||||
| FaxNumber: | 5012027513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 05/17/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A0508056 | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | P0802014 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 2553395 | 01 | AR | CIGNA | OTHER | 710401764 | 01 | AR | CORP HEALTH | OTHER | 15987305566 | 01 | AR | BCBS | OTHER | 08040013300 | 01 | AR | QUAL CHOICE | OTHER | 710401764 | 01 | AR | NOVA SYSTEMS | OTHER | 710401764 | 01 | AR | UNITY MGD CARE | OTHER | 710401764 | 01 | AR | ARCADIAN HEALH PLAN FOR ARK COMMUNIT CARE | OTHER | 116399726 | 05 | AR | MEDICAID | 1098797 | 01 | AR | USA MGD CARE | OTHER | 1598730566 | 01 | AR | MAGELLAN | OTHER | 418023 | 01 | AR | MHN | OTHER |