Healthcare Provider Details

I. General information

NPI: 1467485680
Provider Name (Legal Business Name): TEXARKANA BEHAVIORAL ASSOCIATES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ARKANSAS BLVD
TEXARKANA AR
71854-2107
US

IV. Provider business mailing address

4253 N CROSSOVER RD
FAYETTEVILLE AR
72703-4593
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-5731
  • Fax: 479-521-4926
Mailing address:
  • Phone: 479-521-5731
  • Fax: 479-521-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberPENDING
License Number StateAR

VIII. Authorized Official

Name: BRIAN FARLEY
Title or Position: VICE PRESIDENT & SECRETARY
Credential:
Phone: 615-861-6000