Basic Information
Provider Information | |||||||||
NPI: | 1598793481 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BROWN | ||||||||
FirstName: | ANNA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUGGINS | ||||||||
OtherFirstName: | ANNA | ||||||||
OtherMiddleName: | LEE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LMSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4253 N CROSSOVER RD | ||||||||
Address2: |   | ||||||||
City: | FAYETTEVILLE | ||||||||
State: | AR | ||||||||
PostalCode: | 727034593 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4795215731 | ||||||||
FaxNumber: | 4795216520 | ||||||||
Practice Location | |||||||||
Address1: | 10301 MAYO DR | ||||||||
Address2: |   | ||||||||
City: | BARLING | ||||||||
State: | AR | ||||||||
PostalCode: | 729231660 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4794945760 | ||||||||
FaxNumber: | 4794848142 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/29/2006 | ||||||||
LastUpdateDate: | 09/19/2007 | ||||||||
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 | 1041C0700X | 1072 | OK | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 817-C | AR | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 0076L | AR | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
ID | Type | State | Issuer | Description | 5S890 | 01 | AR | BLUE CROSS | OTHER | 19820200000 | 01 | AR | QUALCHOICE QCA | OTHER | 19518 | 01 | AR | MHN | OTHER |