Healthcare Provider Details

I. General information

NPI: 1821370339
Provider Name (Legal Business Name): KRISTIN BEIGHTOL MSW, LCSW, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E CRANDALL AVE STE B
HARRISON AR
72601-3628
US

IV. Provider business mailing address

2885 W BATTLEFIELD ST
SPRINGFIELD MO
65807-3952
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-8484
  • Fax: 870-741-4088
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number348L
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3213-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: