Healthcare Provider Details

I. General information

NPI: 1831884501
Provider Name (Legal Business Name): CHERYL RAYE COMFORT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GREENWOOD
SILOAM SPRINGS AR
72761-8264
US

IV. Provider business mailing address

104 GREENWOOD
SILOAM SPRINGS AR
72761-8264
US

V. Phone/Fax

Practice location:
  • Phone: 940-206-9415
  • Fax:
Mailing address:
  • Phone: 940-206-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2209024
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: