Provider Demographics
NPI:1972163434
Name:COLLECTIVE PLLC
Entity Type:Organization
Organization Name:COLLECTIVE PLLC
Other - Org Name:THE COLLECTIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYSHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-424-0555
Mailing Address - Street 1:10201 W MARKHAM ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2181
Mailing Address - Country:US
Mailing Address - Phone:501-424-0555
Mailing Address - Fax:501-500-2666
Practice Address - Street 1:10201 W MARKHAM ST STE 203
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2181
Practice Address - Country:US
Practice Address - Phone:501-424-0555
Practice Address - Fax:501-500-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR231027795Medicaid