Provider Demographics
NPI:1083935514
Name:THE HILLCREST CENTER FOR EMOTIONAL WELLBEING
Entity Type:Organization
Organization Name:THE HILLCREST CENTER FOR EMOTIONAL WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-664-4900
Mailing Address - Street 1:2701 KAVANAUGH BLVD
Mailing Address - Street 2:209
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3872
Mailing Address - Country:US
Mailing Address - Phone:501-664-4900
Mailing Address - Fax:501-664-4901
Practice Address - Street 1:2701 KAVANAUGH BLVD
Practice Address - Street 2:209
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3872
Practice Address - Country:US
Practice Address - Phone:501-664-4900
Practice Address - Fax:501-664-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0509059101YP2500X
ARE 1489102L00000X
AR2242-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178446795Medicaid
AR140151001Medicaid
AR169773795Medicaid