Healthcare Provider Details

I. General information

NPI: 1699679100
Provider Name (Legal Business Name): PHOENIX BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N THOMPSON ST
SPRINGDALE AR
72764-3205
US

IV. Provider business mailing address

703 N THOMPSON ST
SPRINGDALE AR
72764-3205
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-3946
  • Fax: 501-499-6639
Mailing address:
  • Phone: 479-751-3946
  • Fax: 501-499-6639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: TINA L WOOD
Title or Position: COO
Credential:
Phone: 501-410-3397