Healthcare Provider Details

I. General information

NPI: 1104855527
Provider Name (Legal Business Name): DOUGLAS SPENCER MONSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 SE WALTON BLVD SUITE C
BENTONVILLE AR
72712-3725
US

IV. Provider business mailing address

4253 N CROSSOVER RD
FAYETTEVILLE AR
72703-4593
US

V. Phone/Fax

Practice location:
  • Phone: 479-464-8081
  • Fax: 479-464-0674
Mailing address:
  • Phone: 479-521-5731
  • Fax: 479-521-4926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1680-C
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004386
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: