Healthcare Provider Details

I. General information

NPI: 1225997836
Provider Name (Legal Business Name): CHAYIM KAVANAH WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W PERSHING BLVD STE C
NORTH LITTLE ROCK AR
72114-2157
US

IV. Provider business mailing address

PO BOX 94052
NORTH LITTLE ROCK AR
72190-4052
US

V. Phone/Fax

Practice location:
  • Phone: 501-247-3656
  • Fax:
Mailing address:
  • Phone: 501-247-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CAREN RENA' MOORE
Title or Position: OWNER
Credential: PHD
Phone: 501-247-3656