Provider Demographics
NPI:1932864154
Name:RINCON, LYTORIA L
Entity type:Individual
Prefix:
First Name:LYTORIA
Middle Name:L
Last Name:RINCON
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:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-630-2328
Mailing Address - Fax:870-662-6826
Practice Address - Street 1:207 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:AR
Practice Address - Zip Code:72360-2071
Practice Address - Country:US
Practice Address - Phone:870-630-2328
Practice Address - Fax:870-662-6826
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA2502021101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator