Provider Demographics
NPI:1427375484
Name:STANFORD, BERNADETTE FAE
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:FAE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W SEARCY ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-3840
Mailing Address - Country:US
Mailing Address - Phone:501-270-9503
Mailing Address - Fax:501-235-3866
Practice Address - Street 1:301 W SEARCY ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-3840
Practice Address - Country:US
Practice Address - Phone:501-270-9503
Practice Address - Fax:501-235-3866
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1412107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional