Most Relevant Information
Provider Data
| NPI Number: | 1003225301 |
| Provider Name: | BRENTON PAUL EZELL LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/12/2014 |
| Last Updated: | 11/29/2023 |
Provider Practice Location
111 S 3RD AVE
PIGGOTT
AR
724542634
Practice Location Phone/Fax
| Phone: | 8705980306 |
| Fax: | 8705980328 |
Provider Mailing Location
1815 PLEASANT GROVE RD
JONESBORO
AR
724057870
Provider Mailing Phone/Fax
| Phone: | 8709336886 |
| Fax: | 8703361339 |