Healthcare Provider Details

I. General information

NPI: 1720582307
Provider Name (Legal Business Name): LAMPSTEAD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 PINE ST STE 4
ARKADELPHIA AR
71923-4368
US

IV. Provider business mailing address

2503 PINE ST STE 4
ARKADELPHIA AR
71923-4368
US

V. Phone/Fax

Practice location:
  • Phone: 580-541-6416
  • Fax: 877-276-1301
Mailing address:
  • Phone: 580-541-6416
  • Fax: 877-276-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. KENYON MARK MOSHER
Title or Position: CEO/THERAPIST
Credential: LPC, LADAC
Phone: 580-541-6416