Healthcare Provider Details

I. General information

NPI: 1235625617
Provider Name (Legal Business Name): HELEN JENNINGS-HOOD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S JEFFERSON ST
DE WITT AR
72042-1929
US

IV. Provider business mailing address

15 SHANNON DR
WYNNE AR
72396-2536
US

V. Phone/Fax

Practice location:
  • Phone: 870-946-8303
  • Fax: 870-946-8217
Mailing address:
  • Phone: 870-375-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2101134
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: