Organization
LIFE TREK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CATHY LYNN STATON PH.D., L.P. (PSYCHOLOGIST)
(501) 617-5678
Entity
Organization
Contact information
Practice address
21 SYCAMORE ST, CABOT, AR 72023-3714
(501) 617-5678
Mailing address
21 SYCAMORE ST, CABOT, AR 72023-3714
(501) 617-5678
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
17-04P
AR
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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