Healthcare Provider Details

I. General information

NPI: 1497726236
Provider Name (Legal Business Name): TINA W EMBRY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CLIFTON ST
CAMDEN AR
71701-3327
US

IV. Provider business mailing address

625 CLIFTON ST
CAMDEN AR
71701-3327
US

V. Phone/Fax

Practice location:
  • Phone: 870-836-9362
  • Fax: 870-836-9363
Mailing address:
  • Phone: 870-836-9362
  • Fax: 870-836-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0207029
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: