Provider Demographics
NPI:1225873425
Name:FALCON, LETZY
Entity type:Individual
Prefix:
First Name:LETZY
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 POINTER TRL W
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2236
Mailing Address - Country:US
Mailing Address - Phone:479-471-1290
Mailing Address - Fax:479-474-5182
Practice Address - Street 1:115 POINTER TRL W
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2236
Practice Address - Country:US
Practice Address - Phone:479-471-1290
Practice Address - Fax:479-474-5182
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician