Healthcare Provider Details

I. General information

NPI: 1912655242
Provider Name (Legal Business Name): SOUTH ARKANSAS PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 MOUNT CARMEL RD
BRYANT AR
72022-6208
US

IV. Provider business mailing address

PO BOX 434
SHERIDAN AR
72150-0434
US

V. Phone/Fax

Practice location:
  • Phone: 501-351-3176
  • Fax: 501-213-0351
Mailing address:
  • Phone: 501-351-3176
  • Fax: 501-213-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: C ALEXANDER WHITE
Title or Position: PRESIDENT
Credential: LPE-I
Phone: 501-351-3176