Healthcare Provider Details

I. General information

NPI: 1821087123
Provider Name (Legal Business Name): OUACHITA REGIONAL COUNSELING & MENTAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WELLNESS WAY
HOT SPRINGS AR
71913-6478
US

IV. Provider business mailing address

125 WELLNESS WAY
HOT SPRINGS AR
71913-6478
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7111
  • Fax: 501-620-5109
Mailing address:
  • Phone: 501-624-7111
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GERSHON
Title or Position: CEO
Credential: PH.D.
Phone: 501-624-7111