Provider Demographics
NPI:1992289151
Name:TDS PSYCHIATRIC SERVICES L.L.C.
Entity type:Organization
Organization Name:TDS PSYCHIATRIC SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-378-6521
Mailing Address - Street 1:78 ENDICOTT TRL
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-8624
Mailing Address - Country:US
Mailing Address - Phone:870-378-6521
Mailing Address - Fax:
Practice Address - Street 1:214 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3102
Practice Address - Country:US
Practice Address - Phone:870-378-6521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-23
Last Update Date:2018-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health