Healthcare Provider Details

I. General information

NPI: 1245529817
Provider Name (Legal Business Name): HEATHER HALLUM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DUVALL

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 W ASH ST STE 2
POTTSVILLE AR
72858-9228
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 479-339-0039
  • Fax: 479-339-0038
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1412121
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: