JEFFERSON COMPREHENSIVE COUNSELING ASSOCIATES INC. NPI 1912342692

NPI Information

NPI: 1912342692
Provider Name: JEFFERSON COMPREHENSIVE COUNSELING ASSOCIATES, INC.
Classification: Clinic/Center - 261QM0850X
Entity Type: Organization

Specialization: Adult Mental Health

CLIA Number: 04D2047299

Address:
5103 W MALCOMB ST
PINE BLUFF, AR
ZIP 71602
Phone: (870) 247-5222
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JEFFERSON COMPREHENSIVE COUNSELING ASSOCIATES, INC. is an adult mental health clinic center in Pine Bluff, AR. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. JEFFERSON COMPREHENSIVE COUNSELING ASSOCIATES, INC. NPI is 1912342692. The provider is registered as an organization entity type.

The provider's business location address is:

5103 W MALCOMB ST
PINE BLUFF, AR
ZIP 71602-649
Phone: (870) 247-5222
Fax: (870) 247-4554

The provider's authorized official is Scott Aaron Mabry .
The authorized official title is Clinical Director and has the following contact phone number (870) 247-5222.

The CLIA number assigned to this NPI record is 04D2047299 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/7/2013 and was last updated on 5/7/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM0850X	Clinic/Center	Adult Mental Health	P1211108	ARKANSAS	Yes

What is NPI?

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This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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