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NPI Code Detail

MEDICARE: CHAYIM KAVANAH WELLNESS LLC

MEDICARE: CHAYIM KAVANAH WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent Psychologist
2103TM1800XIntellectual & Developmental Disabilities Psychologist
3103TS0200XSchool Psychologist
4103T00000XPsychologist

General Provider Information

NPI Number : 1225997836
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHAYIM KAVANAH WELLNESS LLC
Provider Business Mailing Address
First Line : PO BOX 94052
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72190-4052
Country : US
Telephone Number : 501-247-3656
Fax Number :
Provider Business Practice Location Address
First Line : 505 W PERSHING BLVD STE C
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72114-2157
Country : US
Telephone Number : 501-247-3656
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. CAREN RENA' MOORE
Credential : PHD
Telephone Number : 501-247-3656
Provider Enumeration Date : 01/20/2026
Last Update Date : 01/20/2026

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Directions to “CHAYIM KAVANAH WELLNESS LLC ” Practice Location

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