Basic Information
Provider Information | |||||||||
NPI: | 1699976050 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NORTHCOTT | ||||||||
FirstName: | REBECCA | ||||||||
MiddleName: | LEIGH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SMITH | ||||||||
OtherFirstName: | REBECCA | ||||||||
OtherMiddleName: | LEIGH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2400 S. 48TH STREET | ||||||||
Address2: |   | ||||||||
City: | SPRINGDALE | ||||||||
State: | AR | ||||||||
PostalCode: | 72762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4797502020 | ||||||||
FaxNumber: | 4797508967 | ||||||||
Practice Location | |||||||||
Address1: | 2400 S. 48TH STREET | ||||||||
Address2: |   | ||||||||
City: | SPRINDALE | ||||||||
State: | AR | ||||||||
PostalCode: | 72762 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4794437105 | ||||||||
FaxNumber: | 4794432519 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2007 | ||||||||
LastUpdateDate: | 05/19/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0503015 | AR | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 17366 | TX | N |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.