1912655242 NPI number — SOUTH ARKANSAS PSYCHOLOGICAL SERVICES

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 1912655242 NPI number — SOUTH ARKANSAS PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH ARKANSAS PSYCHOLOGICAL SERVICES
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:
1912655242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERIDAN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72150-0434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-351-3176
Provider Business Mailing Address Fax Number:
501-213-0351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3825 MOUNT CARMEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYANT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72022-6208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-351-3176
Provider Business Practice Location Address Fax Number:
501-213-0351
Provider Enumeration Date:
03/15/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
C
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-351-3176

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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