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General NPI Number Information
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NPI Number | 1265860985
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Entity Type | Organization
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Legal Business Name | NORTHWEST ARKANSAS ASSESSMENT AND THERAPY SERVICES, PLLC
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Dates
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Enumeration Date | 10/15/2013
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 26 E MEADOW ST STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5357
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Country | US
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Telephone | 479-790-6290
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10681
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-0046
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Country | US
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Telephone | 479-790-6290
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Fax |
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Authorized Official
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Title or Position | LPE-I
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Name | JENNIFER MOFFITT
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Credential | MA
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Telephone | 479-790-6290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 08-10E
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License Number State | AR
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