Healthcare Provider Details

I. General information

NPI: 1467236638
Provider Name (Legal Business Name): SAMANTHA SONUSTUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 W MAIN ST
CABOT AR
72023-7463
US

IV. Provider business mailing address

3350 W MAIN ST
CABOT AR
72023-7463
US

V. Phone/Fax

Practice location:
  • Phone: 501-274-4422
  • Fax:
Mailing address:
  • Phone: 501-274-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89462
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number971157
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number16910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: