Healthcare Provider Details

I. General information

NPI: 1548863103
Provider Name (Legal Business Name): MARY KATHLEEN BASNETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 40TH ST
ROGERS AR
72758-1643
US

IV. Provider business mailing address

3302 E MOORE AVE
SEARCY AR
72143-5099
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-9088
  • Fax: 479-845-2111
Mailing address:
  • Phone: 501-236-0130
  • Fax: 501-300-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2607010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: