Healthcare Provider Details

I. General information

NPI: 1235736976
Provider Name (Legal Business Name): HALEY MEDFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W SUNBRIDGE DR
FAYETTEVILLE AR
72703-1825
US

IV. Provider business mailing address

1 W SUNBRIDGE DR
FAYETTEVILLE AR
72703-1825
US

V. Phone/Fax

Practice location:
  • Phone: 479-443-5575
  • Fax: 479-443-9554
Mailing address:
  • Phone: 479-443-5575
  • Fax: 479-443-9554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13085-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: