Healthcare Provider Details

I. General information

NPI: 1811014590
Provider Name (Legal Business Name): THE LORDS RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/21/2022
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: 870-647-2541
  • Fax: 870-647-2145
Mailing address:
  • Phone:
  • Fax:

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 SHUL
Title or Position: CEO
Credential:
Phone: 870-647-2541