Healthcare Provider Details

I. General information

NPI: 1609046762
Provider Name (Legal Business Name): ISABELLE DENTON STAGGS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 WOODBINE ST
HOT SPRINGS AR
71901-5122
US

IV. Provider business mailing address

219 WOODBINE ST
HOT SPRINGS AR
71901-5122
US

V. Phone/Fax

Practice location:
  • Phone: 501-545-8039
  • Fax: 501-764-4087
Mailing address:
  • Phone: 501-545-8039
  • Fax: 501-545-8039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0808052
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1112096
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: