=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174806913
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY SUTTLE LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2011
-----------------------------------------------------
Last Update Date | 04/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 MCAULEY CT
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71913-6312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-622-2531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 365 FENDLEY RD
-----------------------------------------------------
City | BISMARCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71929-6591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-230-2115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | P1803032
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------