Healthcare Provider Details

I. General information

NPI: 1710764766
Provider Name (Legal Business Name): FELICIA HOLTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 30TH ST STE D
OZARK AR
72949-3746
US

IV. Provider business mailing address

100 S 30TH ST STE D
OZARK AR
72949-3746
US

V. Phone/Fax

Practice location:
  • Phone: 479-346-2616
  • Fax:
Mailing address:
  • Phone: 479-346-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2607005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: