Provider Demographics
NPI:1649085564
Name:ARKANSAS CHILDRENS PROFESSIONAL SERVICES ORGANIZATION LLC
Entity type:Organization
Organization Name:ARKANSAS CHILDRENS PROFESSIONAL SERVICES ORGANIZATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR CONTROL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-364-2526
Mailing Address - Street 1:PO BOX 959794
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9794
Mailing Address - Country:US
Mailing Address - Phone:501-364-2526
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS WAY # 664
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-978-6436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARKANSAS CHILDRENS PROFESSIONAL SERVICES ORGANIZATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty