Provider Demographics
NPI:1992963151
Name:KIDSCHOICE THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:KIDSCHOICE THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESSIE
Authorized Official - Middle Name:LUVENIA
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-343-9508
Mailing Address - Street 1:32 BROADMOOR DR
Mailing Address - Street 2:PO BOX 4582
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4821
Mailing Address - Country:US
Mailing Address - Phone:501-343-9508
Mailing Address - Fax:
Practice Address - Street 1:32 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-4821
Practice Address - Country:US
Practice Address - Phone:501-343-9508
Practice Address - Fax:501-537-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSCIN22A171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132743785Medicaid
AR164949778Medicaid
AR164950724Medicaid
AR165045742Medicaid