Healthcare Provider Details

I. General information

NPI: 1124144563
Provider Name (Legal Business Name): TEXARKANA BEHAVIORAL ASSOCIATES, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/27/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 N. CROSSOVER RD.
FAYETTEVILLE AR
72703-4593
US

IV. Provider business mailing address

600 TOWER CIRCLE SUITE 1000
FRANKLIN TN
37067
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-5731
  • Fax: 479-521-4926
Mailing address:
  • Phone: 615-861-6000
  • Fax: 479-521-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberAR3849
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: PHILIP P. FARLEY
Title or Position: VP & SECRETARY
Credential:
Phone: 615-861-6000