Healthcare Provider Details

I. General information

NPI: 1780765768
Provider Name (Legal Business Name): ROBERT M STREETT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S MAIN ST SUITE 1
MOUNTAIN HOME AR
72653-4417
US

IV. Provider business mailing address

2153 E JOYCE BLVD SUITE 201
FAYETTEVILLE AR
72703-4714
US

V. Phone/Fax

Practice location:
  • Phone: 870-425-5644
  • Fax: 870-424-2201
Mailing address:
  • Phone: 479-575-9471
  • Fax: 479-587-9392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1768C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: