Healthcare Provider Details

I. General information

NPI: 1982134441
Provider Name (Legal Business Name): GLENNA RODGERS LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLENNA EDWARDS

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 COMMERCIAL CENTER DR STE 2
MARION AR
72364-9616
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 870-732-7920
  • Fax: 870-732-7923
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0611066
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: