Basic Information
| Provider Information | |||||||||
| NPI: | 1417175159 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUOLA | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | LEANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WITHERINGTON | ||||||||
| OtherFirstName: | MISTY | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPE | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 109 W SOUTH ST. | ||||||||
| Address2: | ACA - ARKANSAS COUNSELING ASSOCCIATES | ||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017761191 | ||||||||
| FaxNumber: | 5017761194 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 W SOUTH ST. | ||||||||
| Address2: | ACA | ||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017761191 | ||||||||
| FaxNumber: | 5017761194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 01-21E | AR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 5Y529 | 01 | AR | BCBS | OTHER |