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4001 Commercial Center Dr Ste 2 Marion AR 72364-9616 | |
| (870) 732-7920 | |
| (870) 732-7923 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 4001 Commercial Center Dr Ste 2, Marion, Arkansas |
| Authorized Official Name and Position | Javier Malave (CEO) |
| Authorized Official Contact | 9046054986 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2200 E Matthews Ave Jonesboro AR 72401-4347 Ph: (866) 972-1268 | 4001 Commercial Center Dr Ste 2 Marion AR 72364-9616 Ph: (870) 732-7920 |
| NPI Number | 1366972614 |
|---|---|
| Provider Enumeration Date | 06/19/2017 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366972614 | NPI | - | NPPES |
| 228639526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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