Healthcare Provider Details

I. General information

NPI: 1467182923
Provider Name (Legal Business Name): NORTHWEST ARKANSAS PSYCHOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 LAKEVIEW DR
ROGERS AR
72756-3010
US

IV. Provider business mailing address

PO BOX 184
ROGERS AR
72757-0184
US

V. Phone/Fax

Practice location:
  • Phone: 501-613-7396
  • Fax:
Mailing address:
  • Phone: 501-613-7396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA DUNCAN
Title or Position: MEMBER
Credential: LPC
Phone: 501-613-7396