Provider Demographics
NPI:1831867407
Name:LOFTON, MICHAEL (LAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LOFTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 S 2ND ST STE A
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-7876
Mailing Address - Country:US
Mailing Address - Phone:501-286-6053
Mailing Address - Fax:501-286-6090
Practice Address - Street 1:3358 S 2ND ST STE A
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-7876
Practice Address - Country:US
Practice Address - Phone:501-286-6090
Practice Address - Fax:501-286-6090
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2104009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR272235795Medicaid