Individual
MIRACLE MONK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
121 COMMERCIAL DR # B, STUTTGART, AR 72160-7033
(870) 673-1633
(870) 673-1253
Mailing address
2500 RIKE DR, PINE BLUFF, AR 71603-3937
(870) 534-1834
(870) 534-5798
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PLMSW
AR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224389795
—
AR
Enumeration date
06/16/2015
Last updated
09/20/2023
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