Provider Demographics
NPI:1467975920
Name:PROPST, ELYSSA (LAC)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:
Last Name:PROPST
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 4TH STREET
Mailing Address - Street 2:BMS, ROOM 39 SBMH
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022
Mailing Address - Country:US
Mailing Address - Phone:501-653-5061
Mailing Address - Fax:501-847-5603
Practice Address - Street 1:BRYANT HIGH SCHOOL
Practice Address - Street 2:801 N REYNOLDS ROAD
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-847-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2109022101YM0800X
171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator