Organization · NPI-2

Watch Mountain Clinic

Nurse Practitioner, Psych/Mental Health · Mena, AR

NPI number1659989309

StatusActive

Last updated in NPPESNov 17, 2020

Details

NPI: 1659989309
Entity type: Organization (NPI-2)
Legal business name: Watch Mountain Clinic
Organization subpart: No
Enumeration date: Jul 20, 2020
Certification date: Sep 17, 2020
Last updated: Nov 17, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LP0808X	Nurse Practitioner, Psych/Mental Health	–	–	Yes
261QM0801X	Clinic/Center, Mental Health (Including Community Mental Health Center)	–	–

Practice location

601 Maple Ave
Mena, AR 71953-3227

Phone 479-216-1172

Mailing address

601 Maple Ave
Mena, AR 71953-3227

Phone 479-957-9718

Authorized official

Tonya L Chambers
Owner Of Entity
4799579718

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