Basic Information
| Provider Information | |||||||||
| NPI: | 1578688503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAXUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1033 OLD BURR RD | ||||||||
| Address2: | |||||||||
| City: | WARM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724789077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706472541 | ||||||||
| FaxNumber: | 8706472145 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N ROCKINGCHAIR RD | ||||||||
| Address2: | SUITES 1-3 | ||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724502413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709959617 | ||||||||
| FaxNumber: | 8703359618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHUL | ||||||||
| AuthorizedOfficialFirstName: | TED | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8706472541 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | AR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.