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General NPI Number Information
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NPI Number | 1881132876
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Entity Type | Organization
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Legal Business Name | SUBLETTE THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 02/09/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 2001 CLUB MANOR DR SUITE D
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City | MAUMELLE
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State | AR
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Zip | 72113-7411
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Country | US
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Telephone | 501-352-2429
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Fax |
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Provider Business Mailing Address
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Address Line | 32 BELLE RIVER CV
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City | MAUMELLE
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State | AR
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Zip | 72113-7024
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Country | US
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Telephone | 501-352-2429
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRADLEY CHARLES SUBLETTE
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Credential | LCSW
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Telephone | 501-352-2429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6904-C
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License Number State | AR
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