Healthcare Provider Details

I. General information

NPI: 1861506271
Provider Name (Legal Business Name): LEE HARLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 HIGHWAY 64
AUGUSTA AR
72006-5119
US

IV. Provider business mailing address

108 CHEROKEE DR
SEARCY AR
72143-6523
US

V. Phone/Fax

Practice location:
  • Phone: 870-347-5908
  • Fax: 870-347-1457
Mailing address:
  • Phone: 501-278-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-1011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: