Healthcare Provider Details

I. General information

NPI: 1720288616
Provider Name (Legal Business Name): SUSAN K MCGAUGHEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E CENTERTON BLVD
CENTERTON AR
72719-9240
US

IV. Provider business mailing address

4171 N CROSSOVER RD
FAYETTEVILLE AR
72703-4591
US

V. Phone/Fax

Practice location:
  • Phone: 479-795-1802
  • Fax: 479-795-0332
Mailing address:
  • Phone: 479-521-1532
  • Fax: 479-521-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1693-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: