Healthcare Provider Details

I. General information

NPI: 1295146314
Provider Name (Legal Business Name): MARILYNN MATHEWS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 CENTRAL AVE STE B
HOT SPRINGS AR
71901-6898
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-6000
  • Fax: 501-623-6004
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1612184
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: