Individual
HEAVEN FARMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3205 W MAIN ST, RUSSELLVILLE, AR 72801-2301
(479) 968-5048
Mailing address
3205 W MAIN ST, RUSSELLVILLE, AR 72801-2301
(479) 968-5048
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-78170
AR
Other
Enumeration date
02/05/2021
Last updated
03/17/2025
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