Basic Information
| Provider Information | |||||||||
| NPI: | 1619115052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMAHAN | ||||||||
| FirstName: | BETSY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 75 | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719290075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702456914 | ||||||||
| FaxNumber: | 5013324403 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 N 26TH ST | ||||||||
| Address2: | |||||||||
| City: | ARKADELPHIA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 719234336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702456915 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 04/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P1105030 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.