Healthcare Provider Details

I. General information

NPI: 1942255336
Provider Name (Legal Business Name): MELISSA LOU PECK LPC LMFT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 MCCLAIN RD STE 108
BENTONVILLE AR
72712-6739
US

IV. Provider business mailing address

3801 BUCKINGHAM TER
SPRINGDALE AR
72764-7954
US

V. Phone/Fax

Practice location:
  • Phone: 479-790-7981
  • Fax: 479-935-8611
Mailing address:
  • Phone: 479-790-7981
  • Fax: 479-935-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPO
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMO
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0601006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: