Provider Demographics
| NPI: | 1457984320 |
|---|---|
| Name: | ACTSS A COMMON THREAD SUPPORTIVE SERVICES |
| Entity type: | Organization |
| Organization Name: | ACTSS A COMMON THREAD SUPPORTIVE SERVICES |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ASHLEY |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | FLAKE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | QMHP-C,A |
| Authorized Official - Phone: | 615-347-3115 |
| Mailing Address - Street 1: | 4288 CARTEGENA WAY |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAS VEGAS |
| Mailing Address - State: | NV |
| Mailing Address - Zip Code: | 89121-6504 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 615-347-3115 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 821 N 10TH ST |
| Practice Address - Street 2: | |
| Practice Address - City: | FORT SMITH |
| Practice Address - State: | AR |
| Practice Address - Zip Code: | 72901-1505 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 479-763-1305 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2020-02-19 |
| Last Update Date: | 2022-05-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |
| No | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Single Specialty |
| No | 174200000X | Other Service Providers | Meals | Group - Single Specialty | |
| No | 177F00000X | Other Service Providers | Lodging | ||
| No | 251B00000X | Agencies | Case Management | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 251V00000X | Agencies | Voluntary or Charitable | ||
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1100X | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
