Provider Demographics
NPI:1407028053
Name:SEALES, JANNA E
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:E
Last Name:SEALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 GRAY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3220
Mailing Address - Country:US
Mailing Address - Phone:501-982-3336
Mailing Address - Fax:
Practice Address - Street 1:100 RIVENDELL DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-9188
Practice Address - Country:US
Practice Address - Phone:501-316-1255
Practice Address - Fax:501-316-2221
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health