Provider Demographics
NPI:1538932256
Name:PHOBOS BEHAVIORAL OF FARMINGTON LLC
Entity type:Organization
Organization Name:PHOBOS BEHAVIORAL OF FARMINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, NCSP, LBP
Authorized Official - Phone:539-240-4735
Mailing Address - Street 1:140 SOUTHWINDS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-8688
Mailing Address - Country:US
Mailing Address - Phone:479-267-9015
Mailing Address - Fax:
Practice Address - Street 1:140 SOUTHWINDS RD STE 150
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-8688
Practice Address - Country:US
Practice Address - Phone:479-267-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty