Provider Demographics
NPI:1134959489
Name:CECIL, STEPHANIE ELAINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:CECIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-5024
Mailing Address - Country:US
Mailing Address - Phone:870-741-7600
Mailing Address - Fax:870-741-4520
Practice Address - Street 1:110 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5024
Practice Address - Country:US
Practice Address - Phone:870-741-7600
Practice Address - Fax:870-741-4520
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR26242-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical