| Grace Therapeutics Of Arkansas | |
|
1912 Washington Ave Conway AR 72032-2729 | |
| (870) 623-6299 | |
| Not Available |
| Full Name | Grace Therapeutics Of Arkansas |
|---|---|
| Speciality | Counselor |
| Location | 1912 Washington Ave, Conway, Arkansas |
| Authorized Official Name and Position | Clevelon Lasker (OWNER) |
| Authorized Official Contact | 8706236299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Therapeutics Of Arkansas 1912 Washington Ave Conway AR 72032-2729 Ph: (870) 623-6299 | Grace Therapeutics Of Arkansas 1912 Washington Ave Conway AR 72032-2729 Ph: (870) 623-6299 |
| NPI Number | 1821710955 |
|---|---|
| Provider Enumeration Date | 09/15/2022 |
| Last Update Date | 09/15/2022 |
| Certification Date | 09/15/2022 |
| Medicare PECOS PAC ID | 8527421791 |
|---|---|
| Medicare Enrollment ID | O20230906001123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821710955 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Channing Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104464445 PECOS PAC ID: 4880013713 Enrollment ID: I20200928000275 |
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