Healthcare Provider Details

I. General information

NPI: 1699528257
Provider Name (Legal Business Name): CARLA STOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 SE MOBERLY LN
BENTONVILLE AR
72712-9239
US

IV. Provider business mailing address

802 TYLER ST
CENTERTON AR
72719-7800
US

V. Phone/Fax

Practice location:
  • Phone: 479-530-2545
  • Fax:
Mailing address:
  • Phone: 305-606-9438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2310020
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: