Provider Demographics
NPI:1356855324
Name:CIVILPSYCH, LLC
Entity Type:Organization
Organization Name:CIVILPSYCH, LLC
Other - Org Name:CIVILPSYCH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HEATH
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, NBCFCH, SAP
Authorized Official - Phone:870-932-4744
Mailing Address - Street 1:484 COUNTY ROAD 7593
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7764
Mailing Address - Country:US
Mailing Address - Phone:870-932-4744
Mailing Address - Fax:925-955-4744
Practice Address - Street 1:484 COUNTY ROAD 7593
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7764
Practice Address - Country:US
Practice Address - Phone:870-932-4744
Practice Address - Fax:925-955-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1870-C101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 261Q00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1861565574Medicaid