Individual
TIMOTHY J CHURCHILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6836 ISAAC'S ORCHARD RD, SPRINGDALE, AR 72762
(479) 927-4100
(479) 927-4101
Mailing address
6836 ISAAC'S ORCHARD RD, SPRINGDALE, AR 72762
(479) 927-4100
(479) 927-4101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
238678795
MEDICAID PIN
AR
Enumeration date
11/19/2020
Last updated
11/19/2020
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