Healthcare Provider Details

I. General information

NPI: 1134117906
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5208 KAVANAUGH BLVD SUITE 4
LITTLE ROCK AR
72207-4609
US

IV. Provider business mailing address

5208 KAVANAUGH BLVD SUITE 4
LITTLE ROCK AR
72207-4609
US

V. Phone/Fax

Practice location:
  • Phone: 501-614-7712
  • Fax: 501-614-7708
Mailing address:
  • Phone: 501-614-7712
  • Fax: 501-614-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberE 0973
License Number StateAR

VIII. Authorized Official

Name: DR. SCOTT M HOGAN
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 501-614-7712