Healthcare Provider Details

I. General information

NPI: 1447413968
Provider Name (Legal Business Name): TOSHA MALLETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOSHA STANLEY

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
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 TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1209087
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: