Provider Demographics
NPI:1043661135
Name:SPURGERS, KEVIN NATHANIEL PHELPS (MS, LPC, NCC, TA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:NATHANIEL PHELPS
Last Name:SPURGERS
Suffix:
Gender:M
Credentials:MS, LPC, NCC, TA
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:NATHANIEL
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5324
Mailing Address - Country:US
Mailing Address - Phone:501-208-8062
Mailing Address - Fax:501-208-8062
Practice Address - Street 1:523 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5324
Practice Address - Country:US
Practice Address - Phone:501-208-8062
Practice Address - Fax:501-208-8062
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1906080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health