Healthcare Provider Details

I. General information

NPI: 1265354054
Provider Name (Legal Business Name): COLLECTIVE EMPOWERED HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 S 70TH ST
FORT SMITH AR
72903-5049
US

IV. Provider business mailing address

3017 S 70TH ST
FORT SMITH AR
72903-5049
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-6210
  • Fax:
Mailing address:
  • Phone: 479-222-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MARIA MARTINEZ
Title or Position: OWNER
Credential: LCSW
Phone: 479-459-8258