Basic Information
| Provider Information | |||||||||
| NPI: | 1356598783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NUMAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MHPP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 RIKE DR | ||||||||
| Address2: | |||||||||
| City: | PINE BLUFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 716033937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8705341834 | ||||||||
| FaxNumber: | 8705345798 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 N. OAK ST | ||||||||
| Address2: | |||||||||
| City: | STAR CITY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 71667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703672143 | ||||||||
| FaxNumber: | 8703672145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 03/02/2015 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 116378726 | 05 | AR | MEDICAID |