Healthcare Provider Details

I. General information

NPI: 1679723225
Provider Name (Legal Business Name): CHARLOTTE ANN FEATHERSTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 ARCHER AVE
MAMMOTH SPRING AR
72554-8020
US

IV. Provider business mailing address

PO BOX 1142
MAMMOTH SPRING AR
72554-1142
US

V. Phone/Fax

Practice location:
  • Phone: 870-907-0848
  • Fax: 417-322-6099
Mailing address:
  • Phone: 870-907-0848
  • Fax: 417-322-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2023040471
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP1206072
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA0612081
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: