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General NPI Number Information
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NPI Number | 1376160945
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Entity Type | Organization
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Legal Business Name | SUNRISE OUTREACH SOLUTIONS
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Dates
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Enumeration Date | 06/30/2020
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 7500 DOLLARWAY RD STE 401
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City | WHITE HALL
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State | AR
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Zip | 71602-3083
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Country | US
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Telephone | 870-466-4754
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | SHERIDAN
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State | AR
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Zip | 72150-0622
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Country | US
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Telephone | 870-466-4754
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. NATHAN L CHENNAULT
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Credential |
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Telephone | 870-466-4754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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