Provider Demographics
NPI:1417126582
Name:CHILDREN'S EVALUATION &COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:CHILDREN'S EVALUATION &COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT PSYCHOLOGICAL
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:LPE-I
Authorized Official - Phone:501-776-7708
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-2346
Mailing Address - Country:US
Mailing Address - Phone:501-776-7708
Mailing Address - Fax:
Practice Address - Street 1:212 W. SEVIER
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-776-7708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR92-05 LPE-I251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health