Provider Demographics
NPI:1699804484
Name:ESCALANTE, STANLEY ALLAN (LAC)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:ALLAN
Last Name:ESCALANTE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N 11TH ST APT 44
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-4918
Mailing Address - Country:US
Mailing Address - Phone:870-403-8757
Mailing Address - Fax:
Practice Address - Street 1:1420 PINE ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-4731
Practice Address - Country:US
Practice Address - Phone:870-230-8364
Practice Address - Fax:870-230-8381
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0312103101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor