Healthcare Provider Details

I. General information

NPI: 1396876561
Provider Name (Legal Business Name): LAURA SUZANNE BEWLEY PLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CENTRAL ST
CLARKSVILLE AR
72830-3601
US

IV. Provider business mailing address

PO BOX 23070
BARLING AR
72923-0070
US

V. Phone/Fax

Practice location:
  • Phone: 479-455-5040
  • Fax: 479-452-5047
Mailing address:
  • Phone: 479-452-5040
  • Fax: 479-452-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: