| Moonbrook Mind & Body Integrative Services Incorporated | |
|
4613 Parkway Dr Ste 7 Texarkana AR 71854-1191 | |
| (870) 330-4095 | |
| (844) 706-5741 |
| Full Name | Moonbrook Mind & Body Integrative Services Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 4613 Parkway Dr Ste 7, Texarkana, Arkansas |
| Authorized Official Name and Position | Jessica Kennington (SOCIAL WORKER) |
| Authorized Official Contact | 8703304095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moonbrook Mind & Body Integrative Services Incorporated 4613 Parkway Dr Ste 7 Texarkana AR 71854-1191 Ph: (870) 330-4095 | Moonbrook Mind & Body Integrative Services Incorporated 4613 Parkway Dr Ste 7 Texarkana AR 71854-1191 Ph: (870) 330-4095 |
| NPI Number | 1376173401 |
|---|---|
| Provider Enumeration Date | 01/16/2020 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/11/2023 |
| Medicare PECOS PAC ID | 4284054735 |
|---|---|
| Medicare Enrollment ID | O20201021002858 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376173401 | NPI | - | NPPES |
| Provider Name | Jessica L Kennington |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902219587 PECOS PAC ID: 8820374093 Enrollment ID: I20170425000565 |
| Provider Name | Kelli Mayall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952894545 PECOS PAC ID: 0042662389 Enrollment ID: I20240123000385 |
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