Provider Demographics
NPI:1457723686
Name:HPT EDGE INC.
Entity Type:Organization
Organization Name:HPT EDGE INC.
Other - Org Name:NWA COUNSELOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:VICCARO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:479-310-6382
Mailing Address - Street 1:1601 S RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8821
Mailing Address - Country:US
Mailing Address - Phone:479-310-6382
Mailing Address - Fax:479-254-1099
Practice Address - Street 1:1601 S RAINBOW RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8821
Practice Address - Country:US
Practice Address - Phone:479-310-6382
Practice Address - Fax:479-254-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1505039101YP2500X
CA101YP2500X101YP2500X
ARM1501003106H00000X
MO2013015040106H00000X
CAMFC44465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty