Provider Demographics
NPI:1689546368
Name:MULBERRY LODGE CSSP, LLC
Entity type:Organization
Organization Name:MULBERRY LODGE CSSP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ADMIN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-650-7083
Mailing Address - Street 1:6500 RYE HILL RD E
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-8397
Mailing Address - Country:US
Mailing Address - Phone:479-650-7083
Mailing Address - Fax:479-431-5016
Practice Address - Street 1:949 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MULBERRY
Practice Address - State:AR
Practice Address - Zip Code:72947-8538
Practice Address - Country:US
Practice Address - Phone:479-997-8001
Practice Address - Fax:479-997-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health