Healthcare Provider Details

I. General information

NPI: 1881719052
Provider Name (Legal Business Name): MAXUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W BROADWAY
NORTH LITTLE ROCK AR
72114
US

IV. Provider business mailing address

1033 OLD BURR ROAD
WARM SPRINGS AR
72478
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-2674
  • Fax: 501-955-2754
Mailing address:
  • Phone: 870-647-1400
  • Fax: 870-647-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAR

VIII. Authorized Official

Name: MR. TED SUHL
Title or Position: CEO
Credential:
Phone: 870-647-1400