Provider Demographics
NPI:1548311442
Name:BRISTER, DONNA CHERYL (DO)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:CHERYL
Last Name:BRISTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOUTHWEST ARKANSAS COUNSELING
Mailing Address - Street 2:2904 ARKANSAS BLVD
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:817-798-0014
Mailing Address - Fax:
Practice Address - Street 1:SOUTHWEST ARKANSAS COUNSELING
Practice Address - Street 2:2904 ARKANSAS BLVD
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854
Practice Address - Country:US
Practice Address - Phone:817-798-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003361A2084P0800X
ARE-96702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02003361AOtherINDIANA DO LICENSE
ARE-9670OtherARKANSAS MEDICAL LICENSE