Individual
SIDNEY ICENHOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 W MAIN ST STE 100, RUSSELLVILLE, AR 72801-2803
(479) 968-2001
Mailing address
1310 W MAIN ST STE 201, RUSSELLVILLE, AR 72801-2803
(479) 968-2001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A2602019
AR
Other
Enumeration date
02/18/2026
Last updated
02/18/2026
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