Healthcare Provider Details

I. General information

NPI: 1982938999
Provider Name (Legal Business Name): MATTHEW DAVIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3358 S 2ND ST STE A-C
CABOT AR
72023-7873
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-6053
  • Fax: 501-286-6090
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1608104
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: