Healthcare Provider Details

I. General information

NPI: 1427419266
Provider Name (Legal Business Name): PLAYFUL PATH COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4943 OLD GREENWOOD RD STE 8
FORT SMITH AR
72903-6923
US

IV. Provider business mailing address

4943 OLD GREENWOOD RD STE 8
FORT SMITH AR
72903-6923
US

V. Phone/Fax

Practice location:
  • Phone: 479-274-8132
  • Fax: 479-431-4430
Mailing address:
  • Phone: 479-274-8132
  • Fax: 479-431-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number869-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0906036
License Number StateAR

VIII. Authorized Official

Name: ERICA HUTCHISON
Title or Position: OWNER
Credential: LPC-S
Phone: 479-274-8132