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General NPI Number Information
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NPI Number | 1336670793
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Entity Type | Organization
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Legal Business Name | INVOCATION LLC
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 106 E MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-5128
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Country | US
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Telephone | 479-692-1208
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Fax | 479-968-1673
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 479-498-6700
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Fax | 479-968-4331
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Authorized Official
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Title or Position | OWNER
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Name | PAUL HICKERSON
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Credential | PHD
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Telephone | 479-692-1208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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