Healthcare Provider Details

I. General information

NPI: 1215859996
Provider Name (Legal Business Name): EMMA KATE PHILLEY MS, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8869 US-79 N
PINE BLUFF AR
71603
US

IV. Provider business mailing address

921 N CHESTER ST UNIT B
MONTICELLO AR
71655-4107
US

V. Phone/Fax

Practice location:
  • Phone: 501-737-4320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2607004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: