| |
209 S Lockard St Blytheville AR 72315-2541 | |
(870) 763-2139 | |
(870) 972-4911 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 209 S Lockard St, Blytheville, Arkansas |
Authorized Official Name and Position | Donnie Lyerly (CREDENTIALING) |
Authorized Official Contact | 8709724939 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2707 Browns Ln Jonesboro AR 72401-7213 Ph: (870) 972-4939 | 209 S Lockard St Blytheville AR 72315-2541 Ph: (870) 763-2139 |
NPI Number | 1659664886 |
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Provider Enumeration Date | 05/20/2011 |
Last Update Date | 04/25/2022 |
Certification Date | 04/25/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659664886 | NPI | - | NPPES |
184174774 | Medicaid | AR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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