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>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1154535169

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
2705A OAK LN  VAN BUREN, AR 72956 US
Tel: 479-474-8084  Fax: 479-474-8085

Contact information for business:
2705A OAK LN  VAN BUREN, AR 72956-4816 US
Tel: 479-474-8084  Fax: 479-474-8085

Registration Information:
NPI: 1154535169
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers
N171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:



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