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General NPI Number Information
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NPI Number | 1124744917
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Entity Type | Organization
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Legal Business Name | CAPPS WELLNESS CLINIC AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 623 S PINE ST
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City | HARRISON
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State | AR
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Zip | 72601-5827
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Country | US
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Telephone | 501-278-6688
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Fax | 870-204-5306
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Provider Business Mailing Address
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Address Line | 623 S PINE ST
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City | HARRISON
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State | AR
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Zip | 72601-5827
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Country | US
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Telephone | 501-278-6688
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Fax | 870-204-5306
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. ACACIA LYNETTE JOHNSON
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Credential | ED.S., LPC
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Telephone | 501-278-6688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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