Provider Demographics
NPI:1629800099
Name:THERAPY ASSESSMENT CENTER LLC
Entity type:Organization
Organization Name:THERAPY ASSESSMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:SEWELL
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:501-350-6785
Mailing Address - Street 1:317 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4617
Mailing Address - Country:US
Mailing Address - Phone:501-358-6396
Mailing Address - Fax:
Practice Address - Street 1:317 OAK ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4617
Practice Address - Country:US
Practice Address - Phone:501-358-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPY ASSESSMENT CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty