Provider Demographics
NPI:1699004440
Name:SOUTH ARKANSAS YOUTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTH ARKANSAS YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR/ THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADAC
Authorized Official - Phone:870-836-2321
Mailing Address - Street 1:301A WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701
Mailing Address - Country:US
Mailing Address - Phone:870-836-2321
Mailing Address - Fax:870-837-1195
Practice Address - Street 1:301 W WASHINGTON ST # A
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3959
Practice Address - Country:US
Practice Address - Phone:870-836-2321
Practice Address - Fax:870-837-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management