Provider Demographics
NPI: | 1801436126 |
---|---|
Name: | AR NEXTSTEP COUNSELING SERVICES, LLC |
Entity type: | Organization |
Organization Name: | AR NEXTSTEP COUNSELING SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | KENDELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CAMP |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 870-277-4357 |
Mailing Address - Street 1: | PO BOX 1254 |
Mailing Address - Street 2: | |
Mailing Address - City: | JONESBORO |
Mailing Address - State: | AR |
Mailing Address - Zip Code: | 72403-1254 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-205-9882 |
Mailing Address - Fax: | 870-292-3603 |
Practice Address - Street 1: | 2315 E MATTHEWS AVE |
Practice Address - Street 2: | |
Practice Address - City: | JONESBORO |
Practice Address - State: | AR |
Practice Address - Zip Code: | 72401-4415 |
Practice Address - Country: | US |
Practice Address - Phone: | 870-277-4357 |
Practice Address - Fax: | 870-572-2892 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-01-14 |
Last Update Date: | 2021-05-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |