=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740043025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SISU THERAPY AND CONSULTING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2024
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 MALVERN AVE STE 152
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-418-1000
-----------------------------------------------------
Fax | 888-915-0765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 MALVERN AVE STE 152
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-418-1000
-----------------------------------------------------
Fax | 888-915-0765
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHRYN PAIGE JAGGERS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 501-418-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------