Basic Information
| Provider Information | |||||||||
| NPI: | 1659905396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN ARKANSAS COUNSELING AND GUIDANCE CENTER, INC-RCF CLARKSVILLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11818 | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729171818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794526650 | ||||||||
| FaxNumber: | 4794525847 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 S CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 728303601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794526650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2020 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOLWICK | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | L. 'RUSTI' | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4794526650 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WESTERN ARKANSAS COUNSELING AND GUIDANCE CENTER, INC. | ||||||||
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| AuthorizedOfficialCredential: | LPE-I | ||||||||
| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.