Full Name | |
---|---|
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 |
---|---|
703 Calvin Avery Dr Suite A West Memphis AR 72301-6501 Ph: (870) 732-1878 | 320 Lee Ave Earle AR 72331-2159 Ph: (870) 792-7769 |
NPI Number | 1417193350 |
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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 |