Anderson, Jeremy Russell

Anderson, Jeremy Russell is an sole proprietor health care provider with primary practice located at 1815 Pleasant Grove Road , Jonesboro AR 72401-7870. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Anderson, Jeremy Russell can be contacted via phone (870) 933-6886.

Contact Information

Primary practice address
1815 Pleasant Grove Road Jonesboro AR 72401-7870
Phone: (870) 933-6886
Fax: (870) 933-9395
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X P1307080 Arkansas

Profile Details

NPI number 1003946369
LBN Legal business name Anderson, Jeremy Russell
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 6th, 2007
Last updated Feb 12th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003946369 NPPES
Arkansas Other 5WW07 BCBS

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