Healthcare Provider Details

I. General information

NPI: 1144179177
Provider Name (Legal Business Name): HEARTLAND WELLNESS COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N OKLAHOMA WAY
FAYETTEVILLE AR
72701-4447
US

IV. Provider business mailing address

212 N OKLAHOMA WAY
FAYETTEVILLE AR
72701-4447
US

V. Phone/Fax

Practice location:
  • Phone: 479-595-4077
  • Fax:
Mailing address:
  • Phone: 479-595-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RAMSEY CHAMPAGNE
Title or Position: FOUNDER, COUNSELOR
Credential: LMHC, LPC
Phone: 479-595-4077