Healthcare Provider Details

I. General information

NPI: 1760616791
Provider Name (Legal Business Name): PSYCHIATRIC INSTITUTE OF ARKANSAS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SCOTT ST
LITTLE ROCK AR
72201-4613
US

IV. Provider business mailing address

801 SCOTT ST
LITTLE ROCK AR
72201-4613
US

V. Phone/Fax

Practice location:
  • Phone: 501-221-7238
  • Fax: 501-221-7239
Mailing address:
  • Phone: 501-221-7238
  • Fax: 501-221-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC-5000
License Number StateAR

VIII. Authorized Official

Name: MRS. REBECCA KACZENSKI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 501-221-7238