Provider Demographics
NPI:1134606304
Name:PACE PSYCHOTHERAPY
Entity type:Organization
Organization Name:PACE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRYSTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-350-9590
Mailing Address - Street 1:1605 N FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-5343
Mailing Address - Country:US
Mailing Address - Phone:501-350-9590
Mailing Address - Fax:
Practice Address - Street 1:1605 N FILLMORE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-5343
Practice Address - Country:US
Practice Address - Phone:501-350-9590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7188-C261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health