| Doctor Name: | DR. PORNTHIP CHALUNGSOOTH |
| NPI Number: | 1104911510 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C. |
| License Number: | P9307012 |
| Business Practice Address: | 525 N. Garland Ave. Fayetteville, AR - 72701 |
| Business Phone Number: | 4795755276 |
| Business Fax Number: | 4795757438 |
| Mailing Address: | 1005 E. Rolling Hills Dr., FAYETTEVILLE |
| State: | AR |
| Postal Code: | 72703 |
| Phone Number: | 4795821245 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | P9307012 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |