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General NPI Number Information
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NPI Number | 1528215290
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Entity Type | Organization
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Legal Business Name | ARROWLEAF
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Dates
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Enumeration Date | 08/25/2008
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 406 EAST VINE STREET
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City | VIENNA
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State | IL
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Zip | 62995
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Country | US
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Telephone | 618-658-2611
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Fax | 618-658-2759
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Provider Business Mailing Address
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Address Line | 125 NORTH MARKET STREET PO BOX 759
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City | GOLCONDA
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State | IL
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Zip | 69238-0759
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Country | US
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Telephone | 618-683-2461
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Fax |
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Authorized Official
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Title or Position | FINANCIAL DIRECTOR
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Name | LAURA K COWSER
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Credential |
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Telephone | 618-652-2046
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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 |
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License Number State |
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