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General NPI Number Information
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NPI Number | 1831895085
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Entity Type | Organization
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Legal Business Name | SERENITY MENTAL HEALTHCARE
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 6010 BEAVER CREEK LN
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City | JONESBORO
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State | AR
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Zip | 72404-9558
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Country | US
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Telephone | 629-239-3961
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17328
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City | JONESBORO
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State | AR
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Zip | 72403-6725
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JUELLA SADICON
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Credential | NP
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Telephone | 629-239-3961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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