Provider Demographics
NPI:1417077819
Name:CLINE, JEFF TED (LAC)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:TED
Last Name:CLINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 KEELY CV
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8182
Mailing Address - Country:US
Mailing Address - Phone:870-933-5504
Mailing Address - Fax:
Practice Address - Street 1:4620 KEELY CV
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-8182
Practice Address - Country:US
Practice Address - Phone:870-933-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0610071101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor