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2215 E Oak St Ste 1 Conway AR 72032 | |
| (501) 336-0511 | |
| (501) 336-4037 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2215 E Oak St Ste 1, Conway, Arkansas |
| Authorized Official Name and Position | Shane Frazier (CEO) |
| Authorized Official Contact | 5012233322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2110 Higdon Ferry Rd Ste D Hot Springs AR 71913-7288 Ph: (501) 262-2766 | 2215 E Oak St Ste 1 Conway AR 72032 Ph: (501) 336-0511 |
| NPI Number | 1366477911 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 10/04/2021 |
| Certification Date | 10/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366477911 | NPI | - | NPPES |
| 1366477911 | Medicaid | AR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | AR4343 (Arkansas) | Primary |
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