Provider Demographics
NPI:1538134424
Name:SISSON, ANTHONY (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:SISSON
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 1:110 PEARSON
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4436
Mailing Address - Country:US
Mailing Address - Phone:501-315-4224
Mailing Address - Fax:501-778-0450
Practice Address - Street 1:110 PEARSON
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4436
Practice Address - Country:US
Practice Address - Phone:501-315-4224
Practice Address - Fax:501-778-0450
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0608044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR274009719Medicaid
AR71-0401764OtherCORPHEALTH
AR06100014700OtherQUAL-CHOICE
AR116399726Medicaid
AR5A063OtherBLUE CROSS & BLUE SHIELD
AR710401764SISOtherUNITY MANAGED HEALTH CARE