Individual
SPENCER BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 RIKE DR, PINE BLUFF, AR 71603-3937
(870) 534-1834
(870) 534-5798
Mailing address
2500 RIKE DR, PINE BLUFF, AR 71603-3937
(870) 534-1834
(870) 534-5798
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116378726
—
AR
Enumeration date
05/30/2014
Last updated
05/30/2014
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