Healthcare Provider Details

I. General information

NPI: 1821210386
Provider Name (Legal Business Name): SMALL GROUP THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WHITTINGTON AVENUE
HOT SPRINGS AR
71901
US

IV. Provider business mailing address

311 WHITTINGTON AVENUE
HOT SPRINGS AR
71901-3407
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-3477
  • Fax: 501-624-7498
Mailing address:
  • Phone: 501-623-3477
  • Fax: 501-624-7498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number0000
License Number StateAR

VIII. Authorized Official

Name: WANDA RAPER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 501-623-3477