=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720719495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARSTEN COUNSELING SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2022
-----------------------------------------------------
Last Update Date | 06/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 392 E SUNBRIDGE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-1868
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-366-1720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1216 BRADLEY ST
-----------------------------------------------------
City | CENTERTON
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72719-8008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-366-1720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/CEO
-----------------------------------------------------
Name | AMBER D CARSTEN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 479-366-1720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------