Provider Demographics
NPI:1669853081
Name:ARKANSAS ADULT PSYCHOTHERAPY CENTER, PLLC
Entity Type:Organization
Organization Name:ARKANSAS ADULT PSYCHOTHERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACYE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ENIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-771-4693
Mailing Address - Street 1:5401 JFK BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6756
Mailing Address - Country:US
Mailing Address - Phone:501-758-9993
Mailing Address - Fax:
Practice Address - Street 1:5401 JFK
Practice Address - Street 2:SUITE G
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6756
Practice Address - Country:US
Practice Address - Phone:501-771-4693
Practice Address - Fax:501-771-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty