Healthcare Provider Details

I. General information

NPI: 1245158005
Provider Name (Legal Business Name): JENNIFER HATCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MOUNTAIN ST STE 6
FAYETTEVILLE AR
72701-6067
US

IV. Provider business mailing address

4537 W CANYON RUN DR
FAYETTEVILLE AR
72704-3425
US

V. Phone/Fax

Practice location:
  • Phone: 479-790-1216
  • Fax:
Mailing address:
  • Phone: 479-790-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2601008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: