Provider Demographics
NPI:1437164977
Name:PROFESSIONAL COUNSELING ASSOCIATES INC.
Entity Type:Organization
Organization Name:PROFESSIONAL COUNSELING ASSOCIATES INC.
Other - Org Name:CENTRAL ARKANSAS MENTAL HEALTH SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:797-255-1154
Mailing Address - Street 1:3601 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2954
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:501-221-2376
Practice Address - Street 1:4354 STOCKTON DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2917
Practice Address - Country:US
Practice Address - Phone:501-955-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138580726Medicaid
AR57371OtherARKANSAS BCBS GROUP ID
AR57371Medicare ID - Type UnspecifiedGROUP PROVIDER ID