| Real Development Corporation | |
|
1310 W Main St Ste 201 Russellville AR 72801-2803 | |
| (479) 968-2001 | |
| Not Available |
| Full Name | Real Development Corporation |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1310 W Main St Ste 201, Russellville, Arkansas |
| Authorized Official Name and Position | Jim Knight (PRESIDENT/CEO) |
| Authorized Official Contact | 4799682001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Real Development Corporation 1310 W Main St Ste 201 Russellville AR 72801-2803 Ph: () - | Real Development Corporation 1310 W Main St Ste 201 Russellville AR 72801-2803 Ph: (479) 968-2001 |
| NPI Number | 1568943140 |
|---|---|
| Provider Enumeration Date | 08/22/2018 |
| Last Update Date | 08/09/2022 |
| Certification Date | 08/09/2022 |
| Medicare PECOS PAC ID | 1153751334 |
|---|---|
| Medicare Enrollment ID | O20200501000640 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568943140 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kelsey Leigh Mann Mcclellan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457679011 PECOS PAC ID: 4789902529 Enrollment ID: I20150408000269 |
| Provider Name | Toni Clingmon Jennings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275728974 PECOS PAC ID: 8729412507 Enrollment ID: I20200103000291 |
| Provider Name | Meghan Bratton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487185856 PECOS PAC ID: 6901174903 Enrollment ID: I20220519000632 |
| Provider Name | Javana L Banks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336559699 PECOS PAC ID: 4486002664 Enrollment ID: I20240418000326 |
| Provider Name | Eric Gomance |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326583675 PECOS PAC ID: 9638607005 Enrollment ID: I20250113002469 |
| Provider Name | Shanece Herron |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063898989 PECOS PAC ID: 3375071756 Enrollment ID: I20250113002814 |
| Provider Name | Lorri Jacot |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760864680 PECOS PAC ID: 5597293985 Enrollment ID: I20250113003110 |
| Provider Name | Marilyn Mckown |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033367412 PECOS PAC ID: 7113455502 Enrollment ID: I20250113003180 |
| Provider Name | Valerie Speers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1285151761 PECOS PAC ID: 7214465590 Enrollment ID: I20250114003466 |
| Provider Name | Schanta Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730625153 PECOS PAC ID: 0749630861 Enrollment ID: I20250115002684 |
| Provider Name | Secoyia Key |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1356745707 PECOS PAC ID: 3476082447 Enrollment ID: I20250122000070 |
| Provider Name | Jessica Fleeger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831831833 PECOS PAC ID: 8022547918 Enrollment ID: I20250122001140 |
| Provider Name | Lucas Sandlin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841542024 PECOS PAC ID: 6709315385 Enrollment ID: I20250128000950 |
| Provider Name | Brody Prince |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770002461 PECOS PAC ID: 2668901257 Enrollment ID: I20250128001195 |
| Provider Name | Kasey Knight |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871203190 PECOS PAC ID: 6204366289 Enrollment ID: I20250205003263 |
| Provider Name | Eric Etchison |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275818049 PECOS PAC ID: 9234365206 Enrollment ID: I20250205003845 |
| Provider Name | Garrett Mckown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366115529 PECOS PAC ID: 7618407420 Enrollment ID: I20250210001120 |
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