Healthcare Provider Details

I. General information

NPI: 1164931291
Provider Name (Legal Business Name): PT CONCEPTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WALNUT ST STE 3101
ROGERS AR
72756-3521
US

IV. Provider business mailing address

PO BOX 1509
ROGERS AR
72757-1509
US

V. Phone/Fax

Practice location:
  • Phone: 479-621-0301
  • Fax: 479-866-6300
Mailing address:
  • Phone: 479-621-0301
  • Fax: 479-866-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1103020
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA VIVEROS
Title or Position: DOO
Credential:
Phone: 479-925-8543