Healthcare Provider Details

I. General information

NPI: 1831536549
Provider Name (Legal Business Name): HOT SPRINGS BEHAVIORAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 E GRAND AVE
HOT SPRINGS AR
71901-8673
US

IV. Provider business mailing address

5001 E GRAND AVE
HOT SPRINGS AR
71901-8673
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-1007
  • Fax: 501-623-2252
Mailing address:
  • Phone: 501-623-1007
  • Fax: 501-623-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP0809072
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberE3165
License Number StateAR

VIII. Authorized Official

Name: SHAMSHAD M HAROON
Title or Position: OWNER
Credential: M.D.
Phone: 501-623-1007