|
| |
|
602 David St Corning AR 72422-7268 | |
| (870) 857-3655 | |
| (870) 972-4911 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 602 David St, Corning, Arkansas |
| Authorized Official Name and Position | Donnie Lyerly (PROVIDER CREDENTIALING) |
| Authorized Official Contact | 8709724939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2707 Browns Ln Jonesboro AR 72401-7213 Ph: (870) 972-4939 | 602 David St Corning AR 72422-7268 Ph: (870) 857-3655 |
| NPI Number | 1104077676 |
|---|---|
| Provider Enumeration Date | 10/02/2008 |
| Last Update Date | 04/22/2022 |
| Certification Date | 04/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104077676 | NPI | - | NPPES |
| 172106526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Northeast Arkansas Community Mental Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 602 David St, Corning, AR 72422 Phone: 870-857-3655 |