Healthcare Provider Details

I. General information

NPI: 1588109698
Provider Name (Legal Business Name): RILEY BENJUMEN PATE L.P.C.,L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MCAFEE MEDICAL CIRCLE
BEEBE AR
72012
US

IV. Provider business mailing address

905 MCAFEE MEDICAL CIRCLE
BEEBE AR
72012
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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: