Provider Demographics
NPI:1184075871
Name:BAGGETT, KARISSA LYNN (LAC)
Entity type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:LYNN
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N PECAN ST
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2524
Mailing Address - Country:US
Mailing Address - Phone:501-232-2600
Mailing Address - Fax:501-242-0820
Practice Address - Street 1:106 N PECAN ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2524
Practice Address - Country:US
Practice Address - Phone:501-232-2600
Practice Address - Fax:501-242-0820
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2410017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health