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1310 W Main Street, Suite 100 Russellville AR 72801 | |
| (479) 498-4423 | |
| (479) 498-4425 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1310 W Main Street, Suite 100, Russellville, Arkansas |
| Authorized Official Name and Position | Ted Suhl (CEO) |
| Authorized Official Contact | 8706471400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1033 Old Burr Road Warm Springs AR 72478 Ph: (870) 647-1400 | 1310 W Main Street, Suite 100 Russellville AR 72801 Ph: (479) 498-4423 |
| NPI Number | 1306961495 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 05/20/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306961495 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Arkansas) | Primary |
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