Healthcare Provider Details

I. General information

NPI: 1346171717
Provider Name (Legal Business Name): STEPHEN BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WILHELMINA CV
CONWAY AR
72034-9200
US

IV. Provider business mailing address

1201 OAK ST
CONWAY AR
72032-5316
US

V. Phone/Fax

Practice location:
  • Phone: 501-764-7472
  • Fax:
Mailing address:
  • Phone: 501-764-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JARED STEPHEN
Title or Position: OWNER/PROVIDER
Credential: PMHNP-BC
Phone: 501-764-7472