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General NPI Number Information
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NPI Number | 1245724251
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Entity Type | Organization
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Legal Business Name | STERLING YARD, INC.
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 1200 W WALNUT ST STE B1100
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City | ROGERS
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State | AR
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Zip | 72756-3562
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Country | US
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Telephone | 479-263-7567
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8902
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0016
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Country | US
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Telephone | 479-263-7567
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Fax |
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Authorized Official
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Title or Position | DIR OF BEHAVIORAL HEALTH SERVICES
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Name | DR. RYAN ANDREW MARTIN
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Credential | PHD, LPC, LMFT
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Telephone | 479-263-7567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0610054
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License Number State | AR
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