Provider Demographics
NPI:1306310008
Name:SERVANT'S HEART OUTREACH
Entity type:Organization
Organization Name:SERVANT'S HEART OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:T NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, EDS, NCC, LPC
Authorized Official - Phone:417-268-8086
Mailing Address - Street 1:1200 W WALNUT ST STE 1400J
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3521
Mailing Address - Country:US
Mailing Address - Phone:417-268-8086
Mailing Address - Fax:
Practice Address - Street 1:1200 W WALNUT ST STE 1402
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3521
Practice Address - Country:US
Practice Address - Phone:417-268-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty