Healthcare Provider Details

I. General information

NPI: 1023274347
Provider Name (Legal Business Name): BEVERLY JO BEJARANO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 CADDO ST SUITE 6
ARKADELPHIA AR
71923-5307
US

IV. Provider business mailing address

1036 N. 15TH STREET
ARKADELPHIA AR
71913
US

V. Phone/Fax

Practice location:
  • Phone: 870-230-8217
  • Fax: 870-230-8201
Mailing address:
  • Phone: 870-403-6708
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0702007
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1006044
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR81312
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: