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General NPI Number Information
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NPI Number | 1104376508
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Entity Type | Organization
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Legal Business Name | CBC PROFESSIONALS, LLC
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Dates
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Enumeration Date | 10/10/2016
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 3331 E HERITAGE PKWY
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City | FARMINGTON
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State | AR
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Zip | 72730-5524
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Country | US
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Telephone | 479-879-0094
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Fax | 888-547-7660
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Provider Business Mailing Address
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Address Line | PO BOX 1830
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City | FARMINGTON
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State | AR
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Zip | 72730-1830
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Country | US
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Telephone | 479-879-0094
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Fax | 888-547-7660
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CRISTY BARTLETT
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Credential | LPC
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Telephone | 479-879-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P1306058
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License Number State | AR
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