1972753994 NPI number — SOUTHWEST ARKANSAS COUNSELING AND MENTAL HEALTH CENTER, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972753994 NPI number — SOUTHWEST ARKANSAS COUNSELING AND MENTAL HEALTH CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST ARKANSAS COUNSELING AND MENTAL HEALTH CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972753994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2904 ARKANSAS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71854-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-773-4655
Provider Business Mailing Address Fax Number:
870-772-4650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 WOODRUFF
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADLEY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-894-3366
Provider Business Practice Location Address Fax Number:
870-894-3760
Provider Enumeration Date:
09/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WORLEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
870-773-4655

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 174967526 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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