Healthcare Provider Details

I. General information

NPI: 1790745826
Provider Name (Legal Business Name): MR. MITCHELL WAYNE FRANCIS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 HIGHWAY 71
TEXARKANA AR
71854-1388
US

IV. Provider business mailing address

2904 ARKANSAS BLVD
TEXARKANA AR
71854-2536
US

V. Phone/Fax

Practice location:
  • Phone: 870-774-1615
  • Fax: 870-779-1317
Mailing address:
  • Phone: 870-773-4655
  • Fax: 870-772-4650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0012L
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: