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General NPI Number Information
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NPI Number | 1912655242
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Entity Type | Organization
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Legal Business Name | SOUTH ARKANSAS PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 3825 MOUNT CARMEL RD
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City | BRYANT
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State | AR
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Zip | 72022-6208
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Country | US
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Telephone | 501-351-3176
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Fax | 501-213-0351
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Provider Business Mailing Address
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Address Line | PO BOX 434
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City | SHERIDAN
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State | AR
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Zip | 72150-0434
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Country | US
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Telephone | 501-351-3176
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Fax | 501-213-0351
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Authorized Official
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Title or Position | PRESIDENT
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Name | C ALEXANDER WHITE
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Credential | LPE-I
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Telephone | 501-351-3176
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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