Provider Demographics
NPI:1417175159
Name:JUOLA, MISTY LEANNE (LPE)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEANNE
Last Name:JUOLA
Suffix:
Gender:F
Credentials:LPE
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:E
Other - Last Name:WITHERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPE
Mailing Address - Street 1:109 W SOUTH ST.
Mailing Address - Street 2:ACA - ARKANSAS COUNSELING ASSOCCIATES
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015
Mailing Address - Country:US
Mailing Address - Phone:501-776-1191
Mailing Address - Fax:501-776-1194
Practice Address - Street 1:109 W SOUTH ST.
Practice Address - Street 2:ACA
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015
Practice Address - Country:US
Practice Address - Phone:501-776-1191
Practice Address - Fax:501-776-1194
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR01-21E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y529OtherBCBS