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General NPI Number Information
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NPI Number | 1770227555
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Entity Type | Organization
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Legal Business Name | BRANDED EQUINE BASED THERAPY SERVICES
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Dates
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Enumeration Date | 04/26/2022
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Last Update Date | 05/13/2022
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Provider Practice Location Address
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Address Line | 3917 KEENER LN
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City | HARRISON
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State | AR
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Zip | 72601-7522
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Country | US
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Telephone | 248-709-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 3917 KEENER LN
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City | HARRISON
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State | AR
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Zip | 72601-7522
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Country | US
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Telephone | 248-709-3575
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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 | LINDSEY GABBARD
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Credential | M.S. CCC-SLP
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Telephone | 248-709-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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