Provider Demographics
NPI:1770088338
Name:VETCENTRIC MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:VETCENTRIC MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATERI
Authorized Official - Middle Name:B
Authorized Official - Last Name:KILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-599-9385
Mailing Address - Street 1:17682 RIDGEWAY LN
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-5260
Mailing Address - Country:US
Mailing Address - Phone:479-599-9385
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTHWINDS RD STE 5
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8652
Practice Address - Country:US
Practice Address - Phone:479-267-6934
Practice Address - Fax:866-798-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2463-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty