Provider Demographics
NPI:1164629796
Name:SOUTHERN MENTAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHERN MENTAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-972-1030
Mailing Address - Street 1:1817 WOODSPRINGS RD STE G
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-6093
Mailing Address - Country:US
Mailing Address - Phone:870-972-1030
Mailing Address - Fax:870-972-8603
Practice Address - Street 1:1817 WOODSPRINGS RD STE G
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6093
Practice Address - Country:US
Practice Address - Phone:870-972-1030
Practice Address - Fax:870-972-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F203Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER