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109 S Laredo Ave Russellville AR 72801-4853 | |
| (479) 280-8113 | |
| (479) 431-5014 |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 109 S Laredo Ave, Russellville, Arkansas |
| Authorized Official Name and Position | Beth Stevens (OWNER) |
| Authorized Official Contact | 4792808113 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
272 Stream Rd Russellville AR 72802-1735 Ph: (479) 280-8113 | 109 S Laredo Ave Russellville AR 72801-4853 Ph: (479) 280-8113 |
| NPI Number | 1558178277 |
|---|---|
| Provider Enumeration Date | 12/16/2024 |
| Last Update Date | 01/01/2025 |
| Certification Date | 01/01/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558178277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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