Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILA MAUREEN DEBOSE LCSW (OWNER)
(479) 719-7051
Entity
Organization
Contact information
Practice address
4943 OLD GREENWOOD RD, SUITE 2, FORT SMITH, AR 72903
(479) 719-7051
(478) 242-2653
Mailing address
5410 FREE FERRY RD, FORT SMITH, AR 72903
(479) 719-7051
(479) 242-2653
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
2158-C
AR
251S00000X
Community/Behavioral Health Agency
Primary
—
AR
Other
Enumeration date
03/26/2012
Last updated
04/27/2015
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