Individual
JOHN LARK SHASTEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1803 SW REGIONAL AIRPORT BLVD STE 5, BENTONVILLE, AR 72712-8792
(479) 876-8626
(479) 876-8636
Mailing address
1803 SW REGIONAL AIRPORT BLVD STE 5, BENTONVILLE, AR 72712-8792
(479) 876-8626
(479) 876-8636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-1285
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5S196
BLUE SHIELD PROVIDER #
AR
Enumeration date
07/07/2006
Last updated
06/16/2018
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