| Delta Behavioral Health, Llc | |
|
603 W Fleeman Ste 4 Manila AR 72442-9171 | |
| (870) 570-0358 | |
| (870) 570-0359 |
| Full Name | Delta Behavioral Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 603 W Fleeman Ste 4, Manila, Arkansas |
| Authorized Official Name and Position | Michael Thorpe (OWNER) |
| Authorized Official Contact | 8705700358 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Delta Behavioral Health, Llc Po Box 717 Manila AR 72442-0717 Ph: (870) 570-0358 | Delta Behavioral Health, Llc 603 W Fleeman Ste 4 Manila AR 72442-9171 Ph: (870) 570-0358 |
| NPI Number | 1720637085 |
|---|---|
| Provider Enumeration Date | 09/10/2019 |
| Last Update Date | 10/22/2020 |
| Certification Date | 10/22/2020 |
| Medicare PECOS PAC ID | 6406280007 |
|---|---|
| Medicare Enrollment ID | O20200107000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720637085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Barbara Weaver |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1124074802 PECOS PAC ID: 6002890779 Enrollment ID: I20040618000081 |
| Provider Name | Jim Pang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780690230 PECOS PAC ID: 2769459338 Enrollment ID: I20070113000145 |
| Provider Name | Angie D Hicks-master |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255405353 PECOS PAC ID: 5496858110 Enrollment ID: I20070316000197 |
| Provider Name | Valerie D Brannen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770638355 PECOS PAC ID: 9931234218 Enrollment ID: I20100312000325 |
| Provider Name | Kelli L Statler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023288826 PECOS PAC ID: 4183887052 Enrollment ID: I20120514000413 |
| Provider Name | Jason David Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235755638 PECOS PAC ID: 2062836596 Enrollment ID: I20200716003457 |
| Provider Name | Carol Carle Mcfarlin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639411705 PECOS PAC ID: 5294146270 Enrollment ID: I20201123002580 |
| Provider Name | Stephanie Hanks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831538917 PECOS PAC ID: 6608262738 Enrollment ID: I20220329002837 |
Ka Legacy Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 103 W Fleeman, Manila, AR 72442 Phone: 870-919-6585 |