Provider Demographics
NPI:1316206543
Name:NANCY MILBOURN, LCSW, PA
Entity Type:Organization
Organization Name:NANCY MILBOURN, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MILBOURN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-681-0567
Mailing Address - Street 1:5019 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3627
Mailing Address - Country:US
Mailing Address - Phone:501-681-0567
Mailing Address - Fax:844-274-3173
Practice Address - Street 1:5019 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3627
Practice Address - Country:US
Practice Address - Phone:501-681-0567
Practice Address - Fax:844-274-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC4941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S136OtherPTAN
ARR01601Medicare UPIN