Organization
ASCENT ACQUISITIONS CORP-CYPDC
Active
Other names
CHILD & YOUTH PEDIATRIC DAY CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY ALLGOOD (BILLING SPECIALIST)
(870) 819-0232
Entity
Organization
Contact information
Practice address
1005 BALCOM LN, TRUMANN, AR 72472-9502
(870) 483-1461
(870) 483-6520
Mailing address
3012 TURMAN DR, JONESBORO, AR 72404-8998
(870) 819-0200
(870) 819-0217
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
160747526
—
AR
05
—
160750724
—
AR
05
—
160757742
—
AR
01
—
5C363
BCBS
AR
Enumeration date
03/13/2007
Last updated
04/12/2012
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