Provider Demographics
NPI:1619947447
Name:STALLARD, CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:STALLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2745
Mailing Address - Country:US
Mailing Address - Phone:870-330-4460
Mailing Address - Fax:870-330-4460
Practice Address - Street 1:304 W COLLIN RAYE DR STE 103A
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2000
Practice Address - Country:US
Practice Address - Phone:870-330-4460
Practice Address - Fax:870-330-4460
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR881-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3070014300OtherQUAL-CHOICE
AR946148OtherUSA MANAGED CARE
AR116399726Medicaid
AR71-0401764OtherCORPHEALTH
AR284616000OtherMAGELLAN
AR5S578OtherBLUE CROSS & BLUE SHIELD
AR1051639OtherCIGNA BEHAVIORAL HEALTH
AR184009OtherVALUE OPTIONS
AR184557OtherCOMPSYCH
AR17650OtherUNITED BEHAVIORAH HEALTH
AR41017OtherMHN NETWORK
AR710401764STAOtherUNITY MANAGED M.H. CO.
AR5S578Medicare ID - Type Unspecified