Healthcare Provider Details

I. General information

NPI: 1144398967
Provider Name (Legal Business Name): M ELIZABETH HUFFSTUTTER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STILLWATER DR
JONESBORO AR
72404-9119
US

IV. Provider business mailing address

1900 STILLWATER DR
JONESBORO AR
72404-9119
US

V. Phone/Fax

Practice location:
  • Phone: 870-932-3600
  • Fax: 870-932-3611
Mailing address:
  • Phone: 870-932-3600
  • Fax: 870-932-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2006035359
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number08-18P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: