Healthcare Provider Details

I. General information

NPI: 1568697019
Provider Name (Legal Business Name): KIDS FOR THE FUTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W CHESTNUT ST
MARIANNA AR
72360-2071
US

IV. Provider business mailing address

PO BOX 2192
FORREST CITY AR
72336-2192
US

V. Phone/Fax

Practice location:
  • Phone: 870-630-2328
  • Fax: 870-662-6826
Mailing address:
  • Phone: 870-633-1737
  • Fax: 870-633-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number14012
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number14012
License Number StateAR

VIII. Authorized Official

Name: MRS. BESS GINTY
Title or Position: CEO
Credential:
Phone: 870-633-1737