Provider Demographics
NPI:1194217703
Name:PEDIATRICS PLUS COUNSELING & DIAGNOSTICS
Entity Type:Organization
Organization Name:PEDIATRICS PLUS COUNSELING & DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCARLETT
Authorized Official - Middle Name:RICHARDSON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-821-5459
Mailing Address - Street 1:800 EXCHANGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-7836
Mailing Address - Country:US
Mailing Address - Phone:501-328-3274
Mailing Address - Fax:
Practice Address - Street 1:12921 CANTRELL RD STE 105
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1798
Practice Address - Country:US
Practice Address - Phone:501-891-5492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2084P0005X, 261QM0850X, 261QM0855X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental DisabilitiesGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty