Basic Information
| Provider Information | |||||||||
| NPI: | 1265087274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YODER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 LONGWOOD RD | ||||||||
| Address2: | |||||||||
| City: | CAMMACK VILLAGE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722072716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015410529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10 CORPORATE HILL DR STE 330 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722054528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019547470 | ||||||||
| FaxNumber: | 5019547420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8857-M | AR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.