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General NPI Number Information
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NPI Number | 1205369824
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Entity Type | Organization
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Legal Business Name | SOUTH WIND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 05/11/2024
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Provider Practice Location Address
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Address Line | 3333 S PINNACLE HILLS PKWY STE 435
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City | ROGERS
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State | AR
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Zip | 72758-9095
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Country | US
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Telephone | 479-235-4146
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Fax |
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Provider Business Mailing Address
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Address Line | 11127 E STONEBRIAR DR
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City | BENTONVILLE
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State | AR
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Zip | 72712-8064
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Country | US
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Telephone | 701-740-9624
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALISON TAIT
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Credential | PH.D.
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Telephone | 701-740-9624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 16-22P
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License Number State | AR
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Taxonomy #2
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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 | 16-21P
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License Number State | AR
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