Healthcare Provider Details

I. General information

NPI: 1356742464
Provider Name (Legal Business Name): ZACHARY S HEDGES LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MEDICAL CENTER PKWY
BENTONVILLE AR
72712-3222
US

IV. Provider business mailing address

3202 SW HAZELNUT AVE
BENTONVILLE AR
72713-3195
US

V. Phone/Fax

Practice location:
  • Phone: 479-721-2110
  • Fax:
Mailing address:
  • Phone: 479-636-0083
  • Fax: 479-636-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1907089
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: