Basic Information
| Provider Information | |||||||||
| NPI: | 1508174707 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EARHART | ||||||||
| FirstName: | EUGENA | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2153 E JOYCE BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727034714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795759471 | ||||||||
| FaxNumber: | 4795879392 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 E CENTERTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CENTERTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727199240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797950503 | ||||||||
| FaxNumber: | 4797958303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2010 | ||||||||
| LastUpdateDate: | 09/22/2010 | ||||||||
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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 | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.