Healthcare Provider Details

I. General information

NPI: 1689704322
Provider Name (Legal Business Name): TERRY DOW RHEA SR. LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 HIGHWAY 62 W
GASSVILLE AR
72635-8636
US

IV. Provider business mailing address

7345 HIGHWAY 62 W
GASSVILLE AR
72635-8636
US

V. Phone/Fax

Practice location:
  • Phone: 870-435-5511
  • Fax: 870-435-5513
Mailing address:
  • Phone: 870-435-5511
  • Fax: 870-435-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1636-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: