Healthcare Provider Details

I. General information

NPI: 1184075871
Provider Name (Legal Business Name): KARISSA LYNN BAGGETT LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N PECAN ST
BEEBE AR
72012-2524
US

IV. Provider business mailing address

106 N PECAN ST
BEEBE AR
72012-2524
US

V. Phone/Fax

Practice location:
  • Phone: 501-232-2600
  • Fax: 501-242-0820
Mailing address:
  • Phone: 501-232-2600
  • Fax: 501-242-0820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2410017
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: