Healthcare Provider Details

I. General information

NPI: 1962684563
Provider Name (Legal Business Name): JAMES RICHARD VICCARO LMFT, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S RAINBOW RD
ROGERS AR
72758-8821
US

IV. Provider business mailing address

1601 S RAINBOW RD
ROGERS AR
72758-8821
US

V. Phone/Fax

Practice location:
  • Phone: 479-254-1144
  • Fax: 479-254-1099
Mailing address:
  • Phone: 479-254-1144
  • Fax: 479-254-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 44465
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC 388
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1501003
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2013015040
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1505039
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: