Healthcare Provider Details

I. General information

NPI: 1205794211
Provider Name (Legal Business Name): STEPHANIE A MAASS MS, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 S 54TH ST STE 2
ROGERS AR
72758-8191
US

IV. Provider business mailing address

11399 MILL DAM RD
BENTONVILLE AR
72713-2702
US

V. Phone/Fax

Practice location:
  • Phone: 479-268-4557
  • Fax:
Mailing address:
  • Phone: 479-409-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2511008
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: