Healthcare Provider Details

I. General information

NPI: 1497619290
Provider Name (Legal Business Name): BOECKMANN BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 S HARDING PL
FAYETTEVILLE AR
72701-7030
US

IV. Provider business mailing address

1687 S HARDING PL
FAYETTEVILLE AR
72701-7030
US

V. Phone/Fax

Practice location:
  • Phone: 870-208-3501
  • Fax: 870-208-3501
Mailing address:
  • Phone: 870-208-3501
  • Fax: 870-208-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BLAKE BOECKMANN
Title or Position: OWNER
Credential:
Phone: 870-208-3501