Healthcare Provider Details

I. General information

NPI: 1861979494
Provider Name (Legal Business Name): WILLIAM KYLE PURCELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SALEM RD STE 1
CONWAY AR
72034
US

IV. Provider business mailing address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-8300
  • Fax: 501-329-5508
Mailing address:
  • Phone: 479-968-1298
  • Fax: 479-968-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2008051
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1711322
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: