Healthcare Provider Details

I. General information

NPI: 1639492911
Provider Name (Legal Business Name): ARKANSAS ATTACHMENT & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 S 8TH ST
ROGERS AR
72756-5912
US

IV. Provider business mailing address

PO BOX 346
CAVE SPRINGS AR
72718-0346
US

V. Phone/Fax

Practice location:
  • Phone: 479-366-7920
  • Fax:
Mailing address:
  • Phone: 479-366-7920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP0403014
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM0501001
License Number StateAR

VIII. Authorized Official

Name: SUSAN D. WALKER
Title or Position: OWNER/THERAPIST
Credential: LPC, LMFT
Phone: 479-366-7920