Provider Demographics
NPI:1710230701
Name:TORRES, MAURICE A (COTA)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:A
Last Name:TORRES
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRESSWELL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72714
Mailing Address - Country:US
Mailing Address - Phone:479-619-7787
Mailing Address - Fax:
Practice Address - Street 1:9 CRESSWELL CIRCLE
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714
Practice Address - Country:US
Practice Address - Phone:479-619-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROT-A352261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health