Basic Information
| Provider Information | |||||||||
| NPI: | 1669853081 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS ADULT PSYCHOTHERAPY CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 JFK BLVD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721166756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017589993 | ||||||||
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| Address1: | 5401 JFK | ||||||||
| Address2: | SUITE G | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721166756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017714693 | ||||||||
| FaxNumber: | 5017714885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 07/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | ENIS | ||||||||
| AuthorizedOfficialFirstName: | TRACYE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING AGENT | ||||||||
| AuthorizedOfficialTelephone: | 5017714693 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0809X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult |
No ID Information.