Provider Demographics
NPI:1215208392
Name:SKINNER, MAUREEN E (LPE-I)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:SKINNER
Suffix:
Gender:F
Credentials:LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RED BUD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6119
Mailing Address - Country:US
Mailing Address - Phone:501-500-4114
Mailing Address - Fax:501-764-4555
Practice Address - Street 1:930 WINGATE ST STE E2
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4866
Practice Address - Country:US
Practice Address - Phone:501-500-4114
Practice Address - Fax:501-764-4555
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-03EI101YP2500X, 103TC0700X, 101YP2500X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional