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NPI Code Detail

MEDICARE: REGENA STACY EDSTER LPC

MEDICARE: REGENA STACY EDSTER LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorP1305048AR

General Provider Information

NPI Number : 1568795771
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGENA STACY EDSTER LPC
Provider Business Mailing Address
First Line : 2400 S 48TH ST
Second Line :
City : SPRINGDALE
State : AR
Zip : 72762-6683
Country : US
Telephone Number : 479-750-2020
Fax Number : 479-750-8967
Provider Business Practice Location Address
First Line : 1200 W WALNUT ST
Second Line : SUITE 1400
City : ROGERS
State : AR
Zip : 72756-3521
Country : US
Telephone Number : 479-750-2020
Fax Number : 479-750-8967
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2009
Last Update Date : 04/13/2015

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Directions to “ REGENA STACY EDSTER LPC” Practice Location

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