Provider Demographics
NPI:1073051504
Name:THE DREAM LAB
Entity type:Organization
Organization Name:THE DREAM LAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIZER
Authorized Official - Middle Name:CONTREL
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:870-587-7021
Mailing Address - Street 1:4613 PARKWAY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1142
Mailing Address - Country:US
Mailing Address - Phone:918-510-6066
Mailing Address - Fax:
Practice Address - Street 1:4613 PARKWAY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1142
Practice Address - Country:US
Practice Address - Phone:918-510-6066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty