Healthcare Provider Details

I. General information

NPI: 1154577807
Provider Name (Legal Business Name): KRISTY ANN STATON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTY RIFFEL

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PEARSON
BENTON AR
72015-4436
US

IV. Provider business mailing address

125 DONS WAY
HOT SPRINGS AR
71913-6478
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4224
  • Fax: 501-778-0450
Mailing address:
  • Phone: 501-624-7111
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0901017
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: