Provider Demographics
NPI:1215664099
Name:MOMENTUM THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:MOMENTUM THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:915-300-5534
Mailing Address - Street 1:1017 STEVENSON CV
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-4872
Mailing Address - Country:US
Mailing Address - Phone:915-300-5534
Mailing Address - Fax:
Practice Address - Street 1:2402 WILDWOOD AVE STE 115
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6014
Practice Address - Country:US
Practice Address - Phone:501-983-2199
Practice Address - Fax:501-506-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty