Healthcare Provider Details

I. General information

NPI: 1639104920
Provider Name (Legal Business Name): STACY R ARNELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 DAVID STREET
CORNING AR
72422
US

IV. Provider business mailing address

2707 BROWNS LANE
JONESBORO AR
72401
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-4939
  • Fax: 870-972-4911
Mailing address:
  • Phone: 870-972-4939
  • Fax: 870-972-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1755-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: