Provider Demographics
NPI:1922584184
Name:WIND RIVER THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:WIND RIVER THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-454-5697
Mailing Address - Street 1:PO BOX 250058
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-0058
Mailing Address - Country:US
Mailing Address - Phone:501-454-5697
Mailing Address - Fax:
Practice Address - Street 1:14710 CANTRELL RD STE 7
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4258
Practice Address - Country:US
Practice Address - Phone:501-454-5697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7331-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty