Healthcare Provider Details

I. General information

NPI: 1871236737
Provider Name (Legal Business Name): TRACI WHITWORTH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BRADLEY DR
MOUNTAIN HOME AR
72653-2733
US

IV. Provider business mailing address

10311 W MARKHAM ST
LITTLE ROCK AR
72205-2135
US

V. Phone/Fax

Practice location:
  • Phone: 870-340-2636
  • Fax: 833-226-0134
Mailing address:
  • Phone: 501-781-2230
  • Fax: 833-226-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2608015
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: