Provider Demographics
NPI:1205369824
Name:SOUTH WIND PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTH WIND PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-740-9624
Mailing Address - Street 1:11127 E STONEBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8064
Mailing Address - Country:US
Mailing Address - Phone:701-740-9624
Mailing Address - Fax:
Practice Address - Street 1:803 SE PLAZA AVE STE 7
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-7830
Practice Address - Country:US
Practice Address - Phone:479-595-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-21P261QM0801X
AR16-22P261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)