Provider Demographics
NPI:1548410558
Name:SOUTHWEST ARKANSAS COUNSELING AND MENTAL HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SOUTHWEST ARKANSAS COUNSELING AND MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-773-4655
Mailing Address - Street 1:2904 ARKANSAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-2536
Mailing Address - Country:US
Mailing Address - Phone:870-773-4655
Mailing Address - Fax:870-772-4650
Practice Address - Street 1:351 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-2753
Practice Address - Country:US
Practice Address - Phone:870-898-7234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR137645726Medicaid
AR137645726Medicaid