Healthcare Provider Details

I. General information

NPI: 1669200598
Provider Name (Legal Business Name): ELISE HARRISON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 W BEEBE CAPPS EXPY
SEARCY AR
72143-5169
US

IV. Provider business mailing address

1310 W MAIN ST STE 201
RUSSELLVILLE AR
72801-2803
US

V. Phone/Fax

Practice location:
  • Phone: 501-451-5891
  • Fax:
Mailing address:
  • Phone: 479-968-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2609034
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: