Provider Demographics
NPI:1912655242
Name:SOUTH ARKANSAS PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SOUTH ARKANSAS PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPE-I
Authorized Official - Phone:501-351-3176
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-0434
Mailing Address - Country:US
Mailing Address - Phone:501-351-3176
Mailing Address - Fax:501-213-0351
Practice Address - Street 1:3825 MOUNT CARMEL RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-6208
Practice Address - Country:US
Practice Address - Phone:501-351-3176
Practice Address - Fax:501-213-0351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty