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General NPI Number Information
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NPI Number | 1558880153
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Entity Type | Organization
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Legal Business Name | INNOVATIVE PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 2215 WILDWOOD AVE
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City | SHERWOOD
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State | AR
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Zip | 72120-5089
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Country | US
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Telephone | 501-238-6560
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 241967
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City | LITTLE ROCK
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State | AR
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Zip | 72223-0037
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Country | US
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Telephone | 501-238-6560
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR/ORGANIZER
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Name | DR. YOUSEF ARFAN FAHOUM
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Credential | DRPH, MA, LPE-I
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Telephone | 501-238-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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