Basic Information
| Provider Information | |||||||||
| NPI: | 1578942280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONCRIEF | ||||||||
| FirstName: | ELLEN | ||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 251970 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016606821 | ||||||||
| FaxNumber: | 5016606830 | ||||||||
| Practice Location | |||||||||
| Address1: | 1521 MERRILL DRIVE | ||||||||
| Address2: | STE E200 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016668686 | ||||||||
| FaxNumber: | 5016606830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2015 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A2011170 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.