Provider Demographics
NPI:1134742133
Name:WILLIAM TODD INSTITUTE FOR FAMILY WELLNESS
Entity type:Organization
Organization Name:WILLIAM TODD INSTITUTE FOR FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-810-1645
Mailing Address - Street 1:1374 HIGHWAY 62 W
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-3790
Mailing Address - Country:US
Mailing Address - Phone:833-743-2546
Mailing Address - Fax:
Practice Address - Street 1:1374 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-3790
Practice Address - Country:US
Practice Address - Phone:833-743-2546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty