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General NPI Number Information
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NPI Number | 1689546368
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Entity Type | Organization
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Legal Business Name | MULBERRY LODGE CSSP, LLC
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Dates
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Enumeration Date | 09/22/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 949 N MAIN ST
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City | MULBERRY
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State | AR
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Zip | 72947-8538
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Country | US
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Telephone | 479-997-8001
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Fax | 479-997-1255
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Provider Business Mailing Address
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Address Line | 6500 RYE HILL RD E
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City | FORT SMITH
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State | AR
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Zip | 72916-8397
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Country | US
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Telephone | 479-650-7083
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Fax | 479-431-5016
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Authorized Official
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Title or Position | REGIONAL ADMIN / OWNER
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Name | CLAUDE BRYANT
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Credential |
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Telephone | 479-650-7083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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