Basic Information
| Provider Information | |||||||||
| NPI: | 1497163356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARSON | ||||||||
| FirstName: | RAYMON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 S 48TH ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGDALE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727626683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797502020 | ||||||||
| FaxNumber: | 4797504843 | ||||||||
| Practice Location | |||||||||
| Address1: | 827 W HARVARD ST | ||||||||
| Address2: | |||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795493121 | ||||||||
| FaxNumber: | 4797504843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2014 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7213-M | AR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 7213C | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.