Healthcare Provider Details

I. General information

NPI: 1730137100
Provider Name (Legal Business Name): ANN BEYENKA DUBES PH.D., LPC, NBCC, NG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 N OAK AVE
FAYETTEVILLE AR
72703-1344
US

IV. Provider business mailing address

1302 N OAK AVE
FAYETTEVILLE AR
72703-1344
US

V. Phone/Fax

Practice location:
  • Phone: 479-521-3392
  • Fax:
Mailing address:
  • Phone: 479-521-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP9509028
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberP9509028
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP9509028
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP9509028
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: