Provider Demographics
NPI:1144417171
Name:MAISEN, ADAM NICHOLAS (LPC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:NICHOLAS
Last Name:MAISEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 CLINTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5924
Mailing Address - Country:US
Mailing Address - Phone:870-293-2054
Mailing Address - Fax:870-464-1073
Practice Address - Street 1:812 CLINTON ST STE B
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5924
Practice Address - Country:US
Practice Address - Phone:870-293-2054
Practice Address - Fax:870-464-1073
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP10100171101YP2500X
ARP1010071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional