Healthcare Provider Details

I. General information

NPI: 1972892206
Provider Name (Legal Business Name): MAXUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAIN STREET
LAKE VILLAGE AR
71653
US

IV. Provider business mailing address

1033 OLD BURR RD
WARM SPRINGS AR
72478-9077
US

V. Phone/Fax

Practice location:
  • Phone: 870-265-2186
  • Fax: 870-265-2305
Mailing address:
  • Phone: 870-647-1400
  • Fax: 870-647-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TED SUHL
Title or Position: CEO
Credential:
Phone: 870-647-1400