Healthcare Provider Details

I. General information

NPI: 1932071982
Provider Name (Legal Business Name): ASHTYN BROOKE BECK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 S GRANDVIEW DR
DE WITT AR
72042-3449
US

IV. Provider business mailing address

821 W 5TH ST
DE WITT AR
72042-2303
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-4651
  • Fax:
Mailing address:
  • Phone: 870-509-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2507025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: