Provider Demographics
NPI:1164550760
Name:MARKALLEN BEHAVIORAL HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:MARKALLEN BEHAVIORAL HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:870-946-0158
Mailing Address - Street 1:108 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-1929
Mailing Address - Country:US
Mailing Address - Phone:870-946-0158
Mailing Address - Fax:870-946-0159
Practice Address - Street 1:108 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-1929
Practice Address - Country:US
Practice Address - Phone:870-946-0158
Practice Address - Fax:870-946-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0111048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty