| Healing Hands Addiction Centers Llc | |
|
614 N Martin St Warren AR 71671-1904 | |
| (870) 466-4400 | |
| (870) 466-4556 |
| Full Name | Healing Hands Addiction Centers Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 614 N Martin St, Warren, Arkansas |
| Authorized Official Name and Position | Gary D Mcdougal (COMPLIANCE OFFICER) |
| Authorized Official Contact | 8704897903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healing Hands Addiction Centers Llc 614 N Martin St Warren AR 71671-1904 Ph: (870) 466-4400 | Healing Hands Addiction Centers Llc 614 N Martin St Warren AR 71671-1904 Ph: (870) 466-4400 |
| NPI Number | 1659980159 |
|---|---|
| Provider Enumeration Date | 07/30/2020 |
| Last Update Date | 06/16/2022 |
| Medicare PECOS PAC ID | 7911317581 |
|---|---|
| Medicare Enrollment ID | O20201110002589 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659980159 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Primary |
| Provider Name | Roger A Mason |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1508198201 PECOS PAC ID: 9032018551 Enrollment ID: I20040610001685 |
| Provider Name | Andre Lewis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124048871 PECOS PAC ID: 6709882160 Enrollment ID: I20081126000562 |
| Provider Name | Theresa Ann Lybrand |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659663250 PECOS PAC ID: 6901840263 Enrollment ID: I20110623000366 |
| Provider Name | Jeannie R Tucker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891942975 PECOS PAC ID: 4688978737 Enrollment ID: I20160210000521 |
| Provider Name | Kayley A Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861873929 PECOS PAC ID: 7113285685 Enrollment ID: I20171212000279 |
| Provider Name | Katherine Collins Reynolds |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093089708 PECOS PAC ID: 5092102848 Enrollment ID: I20220425002186 |
| Provider Name | Daniel Bergeron |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538309281 PECOS PAC ID: 5597106252 Enrollment ID: I20240513000379 |
| Provider Name | John Owens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1346564937 PECOS PAC ID: 1153762885 Enrollment ID: I20240513002999 |
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