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General NPI Number Information
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NPI Number | 1992963151
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Entity Type | Organization
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Legal Business Name | KIDSCHOICE THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 32 BROADMOOR DR
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City | LITTLE ROCK
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State | AR
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Zip | 72204-4821
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Country | US
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Telephone | 501-343-9508
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Fax | 501-537-8084
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Provider Business Mailing Address
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Address Line | 32 BROADMOOR DR PO BOX 4582
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City | LITTLE ROCK
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State | AR
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Zip | 72204-4821
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Country | US
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Telephone | 501-343-9508
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ESSIE LUVENIA HEWETT
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Credential |
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Telephone | 501-343-9508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | SCIN22A
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License Number State | AR
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