Healthcare Provider Details

I. General information

NPI: 1558718411
Provider Name (Legal Business Name): ABBY POTEET MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY BOLEN

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19135 HIGHWAY 16
SILOAM SPRINGS AR
72761-9301
US

IV. Provider business mailing address

19135 HIGHWAY 16
SILOAM SPRINGS AR
72761-9301
US

V. Phone/Fax

Practice location:
  • Phone: 479-238-3499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP230617
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: