Provider Demographics
NPI:1508662289
Name:MCGRATH, STEPHANIE DENISE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DENISE
Last Name:MCGRATH
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 TARLETON LN
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-6603
Mailing Address - Country:US
Mailing Address - Phone:479-367-5657
Mailing Address - Fax:
Practice Address - Street 1:808 S WALTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6235
Practice Address - Country:US
Practice Address - Phone:479-367-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2502003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health