Provider Demographics
NPI:1083462980
Name:ODYSSEY THERAPY NWA, LLC
Entity type:Organization
Organization Name:ODYSSEY THERAPY NWA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:479-222-0688
Mailing Address - Street 1:4207 NE BLUE SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4935
Mailing Address - Country:US
Mailing Address - Phone:476-586-1974
Mailing Address - Fax:
Practice Address - Street 1:5310 W VILLAGE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8201
Practice Address - Country:US
Practice Address - Phone:479-222-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty