Healthcare Provider Details

I. General information

NPI: 1588672638
Provider Name (Legal Business Name): THE MENTAL FITNESS CENTER OF THE OZARKS,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 W SHERMAN AVE STE F
HARRISON AR
72601-2743
US

IV. Provider business mailing address

128 SAINT ANDREWS CIR
HIDEAWAY TX
75771-5056
US

V. Phone/Fax

Practice location:
  • Phone: 870-577-2830
  • Fax: 871-741-3457
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number76 19P
License Number StateAR

VIII. Authorized Official

Name: DR. STEPHEN ROBERT HARRIS
Title or Position: PRESIDENT
Credential: PHD
Phone: 870-577-2830