Provider Demographics
NPI:1124744917
Name:CAPPS WELLNESS CLINIC AND ASSOCIATES, INC.
Entity type:Organization
Organization Name:CAPPS WELLNESS CLINIC AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ACACIA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LPC
Authorized Official - Phone:501-278-6688
Mailing Address - Street 1:623 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-5827
Mailing Address - Country:US
Mailing Address - Phone:501-278-6688
Mailing Address - Fax:870-204-5306
Practice Address - Street 1:623 S PINE ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5827
Practice Address - Country:US
Practice Address - Phone:501-278-6688
Practice Address - Fax:870-204-5306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health