Healthcare Provider Details

I. General information

NPI: 1568277960
Provider Name (Legal Business Name): JESSICA ARIVETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 CLUB HOUSE PKWY
FARMINGTON AR
72730-8824
US

IV. Provider business mailing address

11721 CLUB HOUSE PKWY
FARMINGTON AR
72730-8824
US

V. Phone/Fax

Practice location:
  • Phone: 479-567-3967
  • Fax:
Mailing address:
  • Phone: 479-567-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2201017
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberF2205001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: