| Thriveworks Telepsychiatry - Arkansas | |
|
300 N College Ave Ste 305 Fayetteville AR 72701-4381 | |
| (855) 284-7483 | |
| Not Available |
| Full Name | Thriveworks Telepsychiatry - Arkansas |
|---|---|
| Speciality | Counselor |
| Location | 300 N College Ave Ste 305, Fayetteville, Arkansas |
| Authorized Official Name and Position | Anthony Centore (CEO) |
| Authorized Official Contact | 5402176461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Thriveworks Telepsychiatry - Arkansas Po Box 748465 Atlanta GA 30374-8465 Ph: (855) 284-7483 | Thriveworks Telepsychiatry - Arkansas 300 N College Ave Ste 305 Fayetteville AR 72701-4381 Ph: (855) 284-7483 |
| NPI Number | 1669130928 |
|---|---|
| Provider Enumeration Date | 12/03/2021 |
| Last Update Date | 02/11/2025 |
| Certification Date | 02/11/2025 |
| Medicare PECOS PAC ID | 3577950310 |
|---|---|
| Medicare Enrollment ID | O20220427000061 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669130928 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jenna Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790039162 PECOS PAC ID: 6507018769 Enrollment ID: I20121214000394 |
| Provider Name | Devin Annette Devlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396224002 PECOS PAC ID: 7214287077 Enrollment ID: I20180829002030 |
| Provider Name | Martha Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831717115 PECOS PAC ID: 5294150991 Enrollment ID: I20200728003673 |
| Provider Name | Barbara Ann Center |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497909147 PECOS PAC ID: 5890781017 Enrollment ID: I20230814000060 |
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