NPIMap

Organization Active NPI

Life Trek, LLC

  • Counseling Psychologist
  • Cabot, AR
National Provider Identifier
1861925968
Registry record updated Apr 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
17-04P Issued in AR
Legal business name
LIFE TREK, LLC
Practice address
21 Sycamore St
Cabot, AR 72023-3714
Phone
(501) 617-5678
NPI assigned
Apr 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cathy Lynn Staton, PH.D., L.P.
Title
Psychologist
Phone
(501) 617-5678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC1900X 17-04P AR Primary

Addresses

Primary practice location

21 Sycamore St
Cabot, AR 72023-3714

Mailing address

21 Sycamore St
Cabot, AR 72023-3714
Phone (501) 617-5678

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1491350400000",
    "number": "1861925968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 SYCAMORE ST",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720233714",
            "telephone_number": "501-617-5678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 SYCAMORE ST",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720233714",
            "telephone_number": "501-617-5678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TREK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2017-04-05",
        "status": "A",
        "authorized_official_last_name": "STATON",
        "authorized_official_first_name": "CATHY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "501-617-5678",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D., L.P."
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "AR",
            "license": "17-04P",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cabot, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.