Healthcare Provider Details

I. General information

NPI: 1336670793
Provider Name (Legal Business Name): INVOCATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E MAIN ST
RUSSELLVILLE AR
72801-5128
US

IV. Provider business mailing address

PO BOX 9178
RUSSELLVILLE AR
72811-9178
US

V. Phone/Fax

Practice location:
  • Phone: 479-692-1208
  • Fax: 479-968-1673
Mailing address:
  • Phone: 479-498-6700
  • Fax: 479-968-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: PAUL HICKERSON
Title or Position: OWNER
Credential: PHD
Phone: 479-692-1208