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35 Choctaw Trce Cherokee Village AR 72529-2702 | |
| (870) 376-4502 | |
| (870) 376-4619 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 35 Choctaw Trce, Cherokee Village, Arkansas |
| Authorized Official Name and Position | Lesley Don Cole (CFO) |
| Authorized Official Contact | 5016610720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1600 Aldersgate Rd Suite 200 Little Rock AR 72205-6676 Ph: (501) 661-0720 | 35 Choctaw Trce Cherokee Village AR 72529-2702 Ph: (870) 376-4502 |
| NPI Number | 1366680266 |
|---|---|
| Provider Enumeration Date | 01/30/2009 |
| Last Update Date | 04/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366680266 | NPI | - | NPPES |
| 175425526 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |