MEDICARE: ANGELA K STUART LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	P2402004	AR

General Provider Information

NPI Number	:	1568095917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA K STUART LPC

Provider Business Mailing Address
First Line	:	1004 S MOUNT OLIVE ST STE A
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4223
Country	:	US
Telephone Number	:	404-389-1510
Fax Number	:	479-750-4843

Provider Business Practice Location Address
First Line	:	105 E ALPINE ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-3164
Country	:	US
Telephone Number	:	405-389-1510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	05/09/2024

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