Provider Demographics
NPI:1285885608
Name:COUNSELING SERVICES OF EASTERN ARKANSAS
Entity type:Organization
Organization Name:COUNSELING SERVICES OF EASTERN ARKANSAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-972-4939
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:661 ADDISON DR
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-1602
Practice Address - Country:US
Practice Address - Phone:870-238-1135
Practice Address - Fax:870-972-4911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNSELING SERVICES OF EASTERN ARKANSAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-03
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172063526Medicaid
AR5C203Medicare PIN