Provider Demographics
NPI:1093184210
Name:THERAPY ASSESSMENT CENTER, LLC
Entity Type:Organization
Organization Name:THERAPY ASSESSMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:SEWELL
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LP
Authorized Official - Phone:501-291-3091
Mailing Address - Street 1:317 OAK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5679
Mailing Address - Country:US
Mailing Address - Phone:501-291-3091
Mailing Address - Fax:501-588-0484
Practice Address - Street 1:317 OAK ST STE 3
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032
Practice Address - Country:US
Practice Address - Phone:501-291-3091
Practice Address - Fax:501-588-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty