Healthcare Provider Details

I. General information

NPI: 1992463079
Provider Name (Legal Business Name): FORREST C SMITH LPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
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 Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2112005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: