Basic Information
| Provider Information | |||||||||
| NPI: | 1770088338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETCENTRIC MENTAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17682 RIDGEWAY LN | ||||||||
| Address2: | |||||||||
| City: | SILOAM SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727615260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795999385 | ||||||||
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| Practice Location | |||||||||
| Address1: | 128 SOUTHWINDS RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727308652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4792676934 | ||||||||
| FaxNumber: | 8667983345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | KILLMAN | ||||||||
| AuthorizedOfficialFirstName: | KATERI | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4795999385 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2463-C | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.