Healthcare Provider Details

I. General information

NPI: 1962218941
Provider Name (Legal Business Name): MEOSHA TYE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 N 2ND ST
ROGERS AR
72756-6647
US

IV. Provider business mailing address

324 N 2ND ST
ROGERS AR
72756-6647
US

V. Phone/Fax

Practice location:
  • Phone: 479-986-0566
  • Fax:
Mailing address:
  • Phone: 479-986-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10089-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: