Provider Demographics
NPI:1366532749
Name:KVALE, SONJA RUTH (LPC)
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:RUTH
Last Name:KVALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PLAYER LANE
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715
Mailing Address - Country:US
Mailing Address - Phone:479-855-0072
Mailing Address - Fax:479-657-6127
Practice Address - Street 1:5 PLAYER LANE
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715
Practice Address - Country:US
Practice Address - Phone:479-855-0072
Practice Address - Fax:479-657-6127
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPO112052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X343OtherBLUE CROSS BLUE SHIELD