Provider Demographics
NPI:1114203874
Name:FLOYD, ADA (LAC)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11495
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1495
Mailing Address - Country:US
Mailing Address - Phone:479-420-0913
Mailing Address - Fax:479-784-1471
Practice Address - Street 1:7701 S ZERO ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-6644
Practice Address - Country:US
Practice Address - Phone:479-420-0913
Practice Address - Fax:479-784-1471
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1505069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health