Healthcare Provider Details

I. General information

NPI: 1508082074
Provider Name (Legal Business Name): HYTER REZELL ALEXANDER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LEE STREET
EARLE AR
72331
US

IV. Provider business mailing address

320 LEE STREET
EARLE AR
72331
US

V. Phone/Fax

Practice location:
  • Phone: 870-792-7769
  • Fax: 870-792-7561
Mailing address:
  • Phone: 870-792-7769
  • Fax: 870-792-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8166
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8166
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: