=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215913017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THRIVE DEVELOPMENTAL PARTNERS OF ARKANSAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 S. LAWRENCE EXT. STREET
-----------------------------------------------------
City | PORTIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72457-0016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-886-7083
-----------------------------------------------------
Fax | 870-886-2611
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 16
-----------------------------------------------------
City | PORTIA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72457-0016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-886-7083
-----------------------------------------------------
Fax | 870-886-2611
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. LISA ANN WILLIAMS
-----------------------------------------------------
Credential | DIRECTOR
-----------------------------------------------------
Telephone | 870-886-7083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------