Healthcare Provider Details

I. General information

NPI: 1215648670
Provider Name (Legal Business Name): SALT AND LIGHT HOLISTIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13910 OLD MAUMELLE RD
NORTH LITTLE ROCK AR
72113-9004
US

IV. Provider business mailing address

13910 OLD MAUMELLE RD
NORTH LITTLE ROCK AR
72113-9004
US

V. Phone/Fax

Practice location:
  • Phone: 501-777-3170
  • Fax:
Mailing address:
  • Phone: 501-777-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LANELL BURNETT
Title or Position: CO-OWNER/CEO
Credential: APRN
Phone: 501-765-8390