Provider Demographics
NPI:1992552947
Name:MENTAL HEALTH DIAGNOSTICS AND TELEPRESCRIBING
Entity type:Organization
Organization Name:MENTAL HEALTH DIAGNOSTICS AND TELEPRESCRIBING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/INCORPORATOR/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ACUP
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:870-373-1514
Mailing Address - Street 1:801 LEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HORSESHOE BEND
Mailing Address - State:AR
Mailing Address - Zip Code:72512-3918
Mailing Address - Country:US
Mailing Address - Phone:501-344-6154
Mailing Address - Fax:501-344-6154
Practice Address - Street 1:40 PLAZA WAY STE 8
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653
Practice Address - Country:US
Practice Address - Phone:501-344-6154
Practice Address - Fax:501-344-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty