Provider Demographics
NPI:1801665427
Name:HART, LINDSEY (LAC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:HART
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 1:4207 NE BLUE SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4935
Mailing Address - Country:US
Mailing Address - Phone:479-586-1974
Mailing Address - Fax:
Practice Address - Street 1:5310 W VILLAGE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8201
Practice Address - Country:US
Practice Address - Phone:479-222-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2307014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health