Healthcare Provider Details

I. General information

NPI: 1073722344
Provider Name (Legal Business Name): NORTHWEST ARKANSAS COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N SPRING ST
SPRINGDALE AR
72764
US

IV. Provider business mailing address

130 N SPRING ST
SPRINGDALE AR
72764
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-5704
  • Fax:
Mailing address:
  • Phone: 479-751-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP0407033
License Number StateAR

VIII. Authorized Official

Name: MR. WILLIAM DUANE OLDHAM
Title or Position: OWNER
Credential: LPC
Phone: 479-751-5704