Healthcare Provider Details

I. General information

NPI: 1407141583
Provider Name (Legal Business Name): SOUTH ARKANSAS SUBSTANCE ABUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HARGETT DR
EL DORADO AR
71730-6521
US

IV. Provider business mailing address

100 HARGETT DR
EL DORADO AR
71730-6521
US

V. Phone/Fax

Practice location:
  • Phone: 870-881-9301
  • Fax: 870-864-9934
Mailing address:
  • Phone: 870-881-9301
  • Fax: 870-864-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number00078
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS JOHN FRANS
Title or Position: BEHAVIORAL HEALTH SERVICES DIRECTOR
Credential: PH.D.,L.C.S.W.
Phone: 870-881-9301