Basic Information
| Provider Information | |||||||||
| NPI: | 1497993398 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITED METHODIST BEHAVIORAL HEALTH SYSTEMS, INC | ||||||||
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| OtherOrganizationName: | HAZEN OUTPATIENT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 ALDERSGATE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016610720 | ||||||||
| FaxNumber: | 5013257938 | ||||||||
| Practice Location | |||||||||
| Address1: | 477 N HAZEN AVE | ||||||||
| Address2: | |||||||||
| City: | HAZEN | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720648072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016610720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2009 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | CYNDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5018033388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.