Healthcare Provider Details

I. General information

NPI: 1205013893
Provider Name (Legal Business Name): JEREMY STUNTZ-CHRISTIAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 HIGHWAY 62 412
HIGHLAND AR
72542-9477
US

IV. Provider business mailing address

2707 BROWNS LN
JONESBORO AR
72401-7213
US

V. Phone/Fax

Practice location:
  • Phone: 870-856-3337
  • Fax: 870-856-3334
Mailing address:
  • Phone: 870-972-4939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1302016
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: