Healthcare Provider Details

I. General information

NPI: 1902712268
Provider Name (Legal Business Name): HARLEY LAINE WILLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1005 BARBARA ST
MOUNTAIN HOME AR
72653-4245
US

IV. Provider business mailing address

1005 BARBARA ST
MOUNTAIN HOME AR
72653-4245
US

V. Phone/Fax

Practice location:
  • Phone: 870-318-7847
  • Fax:
Mailing address:
  • Phone: 870-318-7847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA2608012
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: