| Doctor Name: | RUSSELL E DEGROAT |
| NPI Number: | 1053675686 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 6549-C |
| Business Practice Address: | 2400 S 48th St Springdale, AR - 727626683 |
| Business Phone Number: | 4797502020 |
| Business Fax Number: | 4797504843 |
| Mailing Address: | 2400 S 48th St, SPRINGDALE |
| State: | AR |
| Postal Code: | 727626683 |
| Phone Number: | 4797502020 |
| Fax Number: | 4797504843 |
| NPI Enumeration Date: | 06/28/2012 |
| NPI Last Update Date: | 05/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 6549-C |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |