Healthcare Provider Details

I. General information

NPI: 1669564852
Provider Name (Legal Business Name): WILLIAM H BOSCHERT LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 W. KEISER AVE
OSCEOLA AR
72370-3409
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 870-622-0592
  • Fax: 870-622-0782
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP9711022
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: