Healthcare Provider Details

I. General information

NPI: 1134252067
Provider Name (Legal Business Name): FROM THE BEGINNING CHMS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S MAIN ST
CAVE CITY AR
72521-9507
US

IV. Provider business mailing address

120 NIX RIDGE RD
ASH FLAT AR
72513-9017
US

V. Phone/Fax

Practice location:
  • Phone: 870-283-1034
  • Fax:
Mailing address:
  • Phone: 870-994-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY JOANN BUNCH
Title or Position: EXECUTIVE DIRECTOR
Credential: LPE,LPC
Phone: 870-994-3103