Provider Demographics
NPI:1558455840
Name:SMALL GROUP THERAPY, INC.
Entity Type:Organization
Organization Name:SMALL GROUP THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-623-3477
Mailing Address - Street 1:311 WHITTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-3407
Mailing Address - Country:US
Mailing Address - Phone:501-623-3477
Mailing Address - Fax:501-624-7498
Practice Address - Street 1:310 WHITTINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3406
Practice Address - Country:US
Practice Address - Phone:501-623-3477
Practice Address - Fax:501-624-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN/A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B092Medicare ID - Type Unspecified