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NPI Code Detail

MEDICARE: PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA

MEDICARE: PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA
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
1251S00000XCommunity/Behavioral Health Agency218949578AR

General Provider Information

NPI Number : 1790082311
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA
Provider Business Mailing Address
First Line : 1327 N WASHINGTON
Second Line :
City : MAGNOLIA
State : AR
Zip : 71753-2067
Country : US
Telephone Number : 870-235-1112
Fax Number : 870-235-1114
Provider Business Practice Location Address
First Line : 1327 N WASHINGTON
Second Line :
City : MAGNOLIA
State : AR
Zip : 71753-2067
Country : US
Telephone Number : 870-235-1112
Fax Number : 870-235-1114
Authorized Official
Title or Position : OWNER/DIRECTOR
Name : MRS. MARIAN F GREEN
Credential : LPC
Telephone Number : 870-235-1112
Provider Enumeration Date : 02/16/2011
Last Update Date : 03/21/2011

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Directions to “PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA ” Practice Location

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