Basic Information
| Provider Information | |||||||||
| NPI: | 1790142925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | CHANEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BCABA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3155 N COLLEGE AVE STE 108 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727033500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799579121 | ||||||||
| FaxNumber: | 4797779967 | ||||||||
| Practice Location | |||||||||
| Address1: | 3155 N COLLEGE AVE STE 108 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727033500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4799579121 | ||||||||
| FaxNumber: | 4797779967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-17-31122 | AR | N | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106E00000X | 0-21-11869 | AR | Y |
No ID Information.