1235548124 NPI number — MRS. WESLEY TOLAND HATCHER LCSW

Table of content: MRS. WESLEY TOLAND HATCHER LCSW (NPI 1235548124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235548124 NPI number — MRS. WESLEY TOLAND HATCHER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATCHER
Provider First Name:
WESLEY
Provider Middle Name:
TOLAND
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235548124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 CALVIN AVERY DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST MEMPHIS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72301-6501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-732-1878
Provider Business Mailing Address Fax Number:
870-735-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 N 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MEMPHIS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72301-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-702-7657
Provider Business Practice Location Address Fax Number:
870-702-7650
Provider Enumeration Date:
08/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203122795 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com