Healthcare Provider Details

I. General information

NPI: 1528987096
Provider Name (Legal Business Name): JOHN AMBROSE BARBUTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 VERSAILLES DR
CABOT AR
72023-3685
US

IV. Provider business mailing address

PO BOX 5104
CABOT AR
72023-5104
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-0096
  • Fax:
Mailing address:
  • Phone: 501-286-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2508007
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: