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General NPI Number Information
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NPI Number | 1073131751
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Entity Type | Individual
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Provider Name | BARBARA DERN LPC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 910 SE 21ST ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-9776
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Country | US
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Telephone | 479-208-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 910 SE 21ST ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-9776
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Country | US
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Telephone | 479-208-7475
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2022034045
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-7727
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2307008
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License Number State | AR
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