Organization
MOUNTAIN TOWN COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER KEPHART LCSW (OWNER/OPERATOR)
(479) 871-7449
Entity
Organization
Contact information
Practice address
4170 W MARTIN LUTHER KING BLVD STE 901, FAYETTEVILLE, AR 72704-7702
(479) 871-7449
Mailing address
4170 W MARTIN LUTHER KING BLVD STE 901, FAYETTEVILLE, AR 72704-7702
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2185-C
AR
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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