Provider Demographics
NPI:1609046762
Name:STAGGS, ISABELLE DENTON (LPC)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:DENTON
Last Name:STAGGS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5122
Mailing Address - Country:US
Mailing Address - Phone:501-545-8039
Mailing Address - Fax:501-545-8039
Practice Address - Street 1:219 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5122
Practice Address - Country:US
Practice Address - Phone:501-545-8039
Practice Address - Fax:501-764-4087
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARP1112096101YP2500X
ARA0808052101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid