| Earle Outpatient Clinic | |
|
320 Lee Ave Earle AR 72331-2159 | |
| (870) 792-7769 | |
| (870) 792-7561 |
| Full Name | Earle Outpatient Clinic |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 320 Lee Ave, Earle, Arkansas |
| Authorized Official Name and Position | Shella Pounds (COMPLIANCE OFFICER) |
| Authorized Official Contact | 8707321878 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Earle Outpatient Clinic 703 Calvin Avery Dr Suite A West Memphis AR 72301-6501 Ph: (870) 732-1878 | Earle Outpatient Clinic 320 Lee Ave Earle AR 72331-2159 Ph: (870) 792-7769 |
| NPI Number | 1417193350 |
|---|---|
| Provider Enumeration Date | 12/24/2008 |
| Last Update Date | 03/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417193350 | NPI | - | NPPES |
| 171503526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 171503526 (Arkansas) | Primary |