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110 Avenue B Jonesboro LA 71251-3512 | |
| (303) 419-1172 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 110 Avenue B, Jonesboro, Louisiana |
| Authorized Official Name and Position | Melinda Ann Clinton (OWNER) |
| Authorized Official Contact | 3034191172 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 71 Jonesboro LA 71251-0071 Ph: (657) 460-8901 | 110 Avenue B Jonesboro LA 71251-3512 Ph: (303) 419-1172 |
| NPI Number | 1508468687 |
|---|---|
| Provider Enumeration Date | 11/12/2020 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Medicare PECOS PAC ID | 2365977048 |
|---|---|
| Medicare Enrollment ID | O20241119002632 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508468687 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Melinda Ann Clinton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962914002 PECOS PAC ID: 9638579097 Enrollment ID: I20241119002775 |
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