Healthcare Provider Details

I. General information

NPI: 1285712588
Provider Name (Legal Business Name): HEATHER DAVIS HUNTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 W TYLER AVE
WEST MEMPHIS AR
72301-4149
US

IV. Provider business mailing address

1026 WARWICK PL
SOUTHAVEN MS
38671-9412
US

V. Phone/Fax

Practice location:
  • Phone: 870-733-1200
  • Fax: 870-732-3269
Mailing address:
  • Phone: 662-536-4591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0110053
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: