MEDICARE: ARKANSAS BEHAVIORAL CENTER (ABC), LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	05-13P	AR

General Provider Information

NPI Number	:	1457609869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARKANSAS BEHAVIORAL CENTER (ABC), LLC

Provider Business Mailing Address
First Line	:	9101 KANIS RD
Second Line	:	#201
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-960-5779
Fax Number	:	501-537-0176

Provider Business Practice Location Address
First Line	:	9101 KANIS RD
Second Line	:	#201
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6456
Country	:	US
Telephone Number	:	501-960-5779
Fax Number	:	501-537-0176

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. KRAMEELAH MARSHAE BANKS
Credential	:	PHD
Telephone Number	:	501-960-5779

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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