Healthcare Provider Details

I. General information

NPI: 1003110420
Provider Name (Legal Business Name): JOSHUA PURSIFULL M.S. L.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W SEARCY ST
HEBER SPRINGS AR
72543-3532
US

IV. Provider business mailing address

PO BOX 2578
BATESVILLE AR
72503-2578
US

V. Phone/Fax

Practice location:
  • Phone: 870-793-8900
  • Fax: 870-793-8959
Mailing address:
  • Phone: 870-793-8900
  • Fax: 870-793-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA1103025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: