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NPI Code Detail

MEDICARE: FORDYCE COUNSELING CLINIC, INC.

MEDICARE: FORDYCE COUNSELING CLINIC, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1912941220
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORDYCE COUNSELING CLINIC, INC.
Provider Business Mailing Address
First Line : 1101 W 3RD ST
Second Line :
City : FORDYCE
State : AR
Zip : 71742-3014
Country : US
Telephone Number : 870-352-5122
Fax Number : 870-352-5127
Provider Business Practice Location Address
First Line : 1101 W 3RD ST
Second Line :
City : FORDYCE
State : AR
Zip : 71742-3014
Country : US
Telephone Number : 870-352-5122
Fax Number : 870-352-5127
Authorized Official
Title or Position : PRESIDENT
Name : MR. DANIEL LOYD MOORE
Credential : M.S., L.A.C.
Telephone Number : 870-352-5122
Provider Enumeration Date : 06/16/2006
Last Update Date : 08/22/2020

Similar Medicare Providers

1902935786 — MR. TAVANTE CALHOUN MHPP
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127
1235268152 — MS. PAM BARTHOLOMEW MHPP
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127
1619006475 — MR. BARRY BRAY MHPP
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127
1982733952 — MR. DAN MOORE M.S., L.A.C.
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127
1871622647 — MRS. STACEY BRUNSON MHPP
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127
1750410544 — MRS. FREDDIE CARR MHPP
Practice Location Address:
1101 W 3RD ST
FORDYCE, AR
71742-3014
Practice Phone: 870-352-5122
Practice Fax: 870-352-5127

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