Healthcare Provider Details

I. General information

NPI: 1184954703
Provider Name (Legal Business Name): LINDA MAE MORTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LINDA MAE VAUGHAN

II. Dates (important events)

Enumeration Date: 01/04/2010
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
LAMAR AR
72846-7401
US

IV. Provider business mailing address

602 N WALTON BLVD
BENTONVILLE AR
72712-4576
US

V. Phone/Fax

Practice location:
  • Phone: 479-733-0400
  • Fax: 479-733-0403
Mailing address:
  • Phone: 479-733-0400
  • Fax: 479-733-0403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2424-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: