Provider Demographics
NPI:1770139941
Name:TEXARKANA PSYCHIATRIC SERVICES, PLLC
Entity type:Organization
Organization Name:TEXARKANA PSYCHIATRIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APN
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:870-773-1711
Mailing Address - Street 1:2116 N STATE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2116 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-3583
Practice Address - Country:US
Practice Address - Phone:870-773-1711
Practice Address - Fax:870-773-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992081491OtherINDIVIDUAL NPI