Provider Demographics
NPI:1669145694
Name:PINK ELEPHANT THERAPY
Entity type:Organization
Organization Name:PINK ELEPHANT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:DELORA
Authorized Official - Last Name:TAUTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, AADC, LADAC
Authorized Official - Phone:870-866-4653
Mailing Address - Street 1:203 W. MAIN ST.
Mailing Address - Street 2:SUITE K
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-866-4653
Mailing Address - Fax:
Practice Address - Street 1:203 W MAIN ST STE K
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-5604
Practice Address - Country:US
Practice Address - Phone:870-866-4653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-27
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health