| Marianna Outpatient Program | |
|
703 Calvin Avery Dr West Memphis AR 72301-6501 | |
| (870) 732-1817 | |
| (870) 702-7111 |
| Full Name | Marianna Outpatient Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 703 Calvin Avery Dr, West Memphis, Arkansas |
| Authorized Official Name and Position | Shella Pounds (COMPLIANCE OFFICER) |
| Authorized Official Contact | 8707350300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Marianna Outpatient Program 63 N Carolina St Marianna AR 72360-2002 Ph: (870) 295-3300 | Marianna Outpatient Program 703 Calvin Avery Dr West Memphis AR 72301-6501 Ph: (870) 732-1817 |
| NPI Number | 1326284266 |
|---|---|
| Provider Enumeration Date | 12/24/2008 |
| Last Update Date | 08/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326284266 | NPI | - | NPPES |
| 171504526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 171504526 (Arkansas) | Primary |
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