Provider Demographics
NPI:1336633387
Name:CENTER FOR EATING DISORDERS AND BEHAVIORAL WELLNESS PLC
Entity Type:Organization
Organization Name:CENTER FOR EATING DISORDERS AND BEHAVIORAL WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-761-4796
Mailing Address - Street 1:218 UNION ST STE C
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-2831
Mailing Address - Country:US
Mailing Address - Phone:870-530-6104
Mailing Address - Fax:
Practice Address - Street 1:218 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2831
Practice Address - Country:US
Practice Address - Phone:870-530-6104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6572-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty