Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | P1702237 | AR |
NPI | 1003233693 |
---|---|
Provider Name | Mrs. Peggy Burt |
First Address | Arkadelphia, AR 71923-4368 |
Second Address | Arkadelphia, AR 71923-5307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2014 |
Last Update Date | 25/07/2019 |