Healthcare Provider Details

I. General information

NPI: 1720618267
Provider Name (Legal Business Name): CHANTAL BRICE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

IV. Provider business mailing address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-1298
  • Fax: 479-968-6053
Mailing address:
  • Phone: 479-967-5570
  • Fax: 479-890-5364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2209020
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2001010
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: