Healthcare Provider Details

I. General information

NPI: 1275018202
Provider Name (Legal Business Name): CONCHO VALLEY COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HUSKINS PL
BELLA VISTA AR
72715-2911
US

IV. Provider business mailing address

1 HUSKINS PL
BELLA VISTA AR
72715-2911
US

V. Phone/Fax

Practice location:
  • Phone: 325-212-9268
  • Fax:
Mailing address:
  • Phone: 325-212-9268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: TARA JOINER
Title or Position: OWNER & LPC
Credential:
Phone: 325-212-9268