Provider Demographics
NPI:1104028703
Name:MATTINGLY, ALISHA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:MARIE
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN ST
Mailing Address - Street 2:SUITE V
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4905
Mailing Address - Country:US
Mailing Address - Phone:501-321-8200
Mailing Address - Fax:
Practice Address - Street 1:600 MAIN ST
Practice Address - Street 2:SUITE V
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4905
Practice Address - Country:US
Practice Address - Phone:501-321-8200
Practice Address - Fax:501-321-8202
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0705022101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional