Provider Demographics
NPI:1669254181
Name:MACI SCUDDER THERAPY
Entity type:Organization
Organization Name:MACI SCUDDER THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MACI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SCUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-492-6860
Mailing Address - Street 1:2020 W 3RD ST STE 500C
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4466
Mailing Address - Country:US
Mailing Address - Phone:501-492-6860
Mailing Address - Fax:501-406-3671
Practice Address - Street 1:2020 W 3RD ST STE 500C
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4466
Practice Address - Country:US
Practice Address - Phone:501-492-6860
Practice Address - Fax:501-406-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1326524927Medicaid
AR1669524181Medicaid