Healthcare Provider Details

I. General information

NPI: 1174617526
Provider Name (Legal Business Name): CENTERS FOR YOUTH AND FAMILIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W. 12TH STREET
LITTLE ROCK AR
72204
US

IV. Provider business mailing address

PO BOX 251970
LITTLE ROCK AR
72225-1970
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-8686
  • Fax: 501-666-6838
Mailing address:
  • Phone: 501-666-8686
  • Fax: 501-660-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUG STADTER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 501-666-8686