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General NPI Number Information
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NPI Number | 1720751373
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Entity Type | Organization
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Legal Business Name | OUR BROTHER'S KEEPER WELLNESS ORGANIZATION
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 7101 W 12TH ST STE 200I
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City | LITTLE ROCK
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State | AR
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Zip | 72204-2404
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Country | US
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Telephone | 501-647-1042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 46346
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City | LITTLE ROCK
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State | AR
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Zip | 72214-6346
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Country | US
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Telephone | 501-647-1042
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TANYA MARYIE BELL-BROOKS
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Credential |
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Telephone | 501-412-2268
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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