Basic Information
| Provider Information | |||||||||
| NPI: | 1659555316 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEUTIC FAMILY SERVICES/M&M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718458502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709213800 | ||||||||
| FaxNumber: | 8709213841 | ||||||||
| Practice Location | |||||||||
| Address1: | 626 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | LEWISVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 718458502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709213800 | ||||||||
| FaxNumber: | 8709213841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | SCHOOLEY | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 9039089940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | R73150 | AR | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.