Provider Demographics
NPI:1467483677
Name:TEXARKANA BEHAVIORAL ASSOCIATES, L.C.
Entity Type:Organization
Organization Name:TEXARKANA BEHAVIORAL ASSOCIATES, L.C.
Other - Org Name:VALLEY BEHAVIORAL HEALTH SYSTEM OUTPATIENT PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:FARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-861-6000
Mailing Address - Street 1:830 CRESCENT CENTRE DRIVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:615-861-6000
Mailing Address - Fax:615-261-9685
Practice Address - Street 1:815A FORT STREET
Practice Address - Street 2:
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923
Practice Address - Country:US
Practice Address - Phone:479-494-5700
Practice Address - Fax:479-494-5777
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXARKANA BEHAVIORAL ASSOCIATES, L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
ARAR4283261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200012010AMedicaid
AR152583726Medicaid
AR5C855OtherBLUE CROSS GROUP
AR152583726Medicaid