Basic Information
| Provider Information | |||||||||
| NPI: | 1144731837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURST | ||||||||
| FirstName: | ROY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 N WALTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BENTONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727124576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794641060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1820 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | HOT SPRINGS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719016847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016090400 | ||||||||
| FaxNumber: | 5016090166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2017 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.