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General NPI Number Information
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NPI Number | 1992289151
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Entity Type | Organization
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Legal Business Name | TDS PSYCHIATRIC SERVICES L.L.C.
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Dates
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Enumeration Date | 09/23/2018
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Last Update Date | 09/23/2018
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Provider Practice Location Address
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Address Line | 214 E WASHINGTON AVE
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City | JONESBORO
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State | AR
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Zip | 72401-3102
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Country | US
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Telephone | 870-378-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 78 ENDICOTT TRL
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City | POCAHONTAS
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State | AR
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Zip | 72455-8624
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Country | US
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Telephone | 870-378-6521
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Fax |
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Authorized Official
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Title or Position | APRN
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Name | TIFFANY SPARGO
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Credential |
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Telephone | 870-378-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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