Provider Demographics
NPI:1164813291
Name:PSYCHOLOGICAL CARE SERVICES OF AR LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CARE SERVICES OF AR LLC
Other - Org Name:PSYCHOLOGICAL CARE SERVICES OF AR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-2513
Mailing Address - Street 1:109 DOUBLOON DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-2715
Mailing Address - Country:US
Mailing Address - Phone:985-641-2513
Mailing Address - Fax:985-265-4155
Practice Address - Street 1:609 SW 8TH STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:985-641-2513
Practice Address - Fax:985-265-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty