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750 Bridges Ave E Ste A Wynne AR 72396-2343 | |
| (501) 316-1255 | |
| (501) 316-0908 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 750 Bridges Ave E Ste A, Wynne, Arkansas |
| Authorized Official Name and Position | Scott Williams (CEO) |
| Authorized Official Contact | 5013161255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
750 Bridges Ave E Ste A Wynne AR 72396-2343 Ph: (501) 316-1255 | 750 Bridges Ave E Ste A Wynne AR 72396-2343 Ph: (501) 316-1255 |
| NPI Number | 1740456060 |
|---|---|
| Provider Enumeration Date | 05/06/2008 |
| Last Update Date | 05/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740456060 | NPI | - | NPPES |
| 167275526 | 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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