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General NPI Number Information
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NPI Number | 1548863103
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Entity Type | Individual
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Provider Name | MARY KATHLEEN BASNETT LAC
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Gender | Female
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 501 S 40TH ST STE 101
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City | ROGERS
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State | AR
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Zip | 72758-1626
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Country | US
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Telephone | 479-202-8040
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S 48TH ST
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City | SPRINGDALE
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State | AR
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Zip | 72762-6683
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Country | US
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Telephone | 479-750-2020
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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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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