Healthcare Provider Details

I. General information

NPI: 1437587169
Provider Name (Legal Business Name): MAXUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 OLD BURR RD
WARM SPRINGS AR
72478-9077
US

IV. Provider business mailing address

1033 OLD BURR RD
WARM SPRINGS AR
72478-9077
US

V. Phone/Fax

Practice location:
  • Phone: 870-647-1400
  • Fax: 870-647-2337
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: TED SUHL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 870-647-1400