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General NPI Number Information
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NPI Number | 1811797673
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Entity Type | Organization
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Legal Business Name | PILOTAGE HEALING INC.
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 4979 OLD GREENWOOD RD STE B2
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City | FORT SMITH
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State | AR
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Zip | 72903-6906
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Country | US
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Telephone | 479-289-5220
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Fax |
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Provider Business Mailing Address
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Address Line | 775 LAUREL DR
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City | GREENWOOD
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State | AR
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Zip | 72936-5714
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Country | US
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Telephone | 479-445-9814
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | VAUGHN DECOSTER
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Credential | PHD
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Telephone | 479-445-9814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/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 | 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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