MEDICARE: COUNSELING ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1457832172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	110 SKYLINE DR
Second Line	:
City	:	RUSSELLVILLE
State	:	AR
Zip	:	72801-3362
Country	:	US
Telephone Number	:	479-968-1298
Fax Number	:	479-968-6053

Provider Business Practice Location Address
First Line	:	2526 HIGHWAY 65 S STE 201
Second Line	:
City	:	CLINTON
State	:	AR
Zip	:	72031-6678
Country	:	US
Telephone Number	:	479-968-1298
Fax Number	:	479-968-6053

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	BRIAN LUTZ
Credential	:
Telephone Number	:	479-967-5570

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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