Healthcare Provider Details

I. General information

NPI: 1972071587
Provider Name (Legal Business Name): MADISON MARIE MEYERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W CENTER ST STE 420
FAYETTEVILLE AR
72701-6073
US

IV. Provider business mailing address

1722 N COLLEGE AVE STE C
FAYETTEVILLE AR
72703-2640
US

V. Phone/Fax

Practice location:
  • Phone: 479-301-5290
  • Fax:
Mailing address:
  • Phone: 479-318-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9236-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: