Healthcare Provider Details

I. General information

NPI: 1093901928
Provider Name (Legal Business Name): LISA BALDWIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BALDWIN MHPP

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 LOWER RIDGE RD
CONWAY AR
72032
US

IV. Provider business mailing address

1700 HOSTA
CONWAY AR
72034-8484
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-3344
  • Fax:
Mailing address:
  • Phone: 870-588-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1808106
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: