Provider Demographics
NPI:1992164263
Name:STATON, CATHY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:CATHY
Middle Name:LYNN
Last Name:STATON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TRIVISTA RIGHT ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS NATIONAL PARK
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7502
Mailing Address - Country:US
Mailing Address - Phone:501-617-5678
Mailing Address - Fax:
Practice Address - Street 1:320 OUACHITA AVE STE 210
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS NATIONAL PARK
Practice Address - State:AR
Practice Address - Zip Code:71901-5189
Practice Address - Country:US
Practice Address - Phone:501-617-5678
Practice Address - Fax:501-701-4014
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15-05AP-PL103T00000X
AR17-04P103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist