Healthcare Provider Details

I. General information

NPI: 1639400294
Provider Name (Legal Business Name): MAUREEN ELIZABETH RYAN-MCGEHEE LPE-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 HIGHWAY 65 S STE 201
CLINTON AR
72031
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-8007
  • Fax: 479-890-5364
Mailing address:
  • Phone: 479-750-2020
  • Fax: 479-750-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10-16EI
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number10-16E1
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: