Healthcare Provider Details

I. General information

NPI: 1679363527
Provider Name (Legal Business Name): COUNSELING CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COTTAGE HILL DRIVE
BENTON AR
72015
US

IV. Provider business mailing address

110 PEARSON
BENTON AR
72015-4436
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4224
  • Fax: 501-778-0450
Mailing address:
  • Phone: 501-315-4224
  • Fax: 501-778-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHY DUKE
Title or Position: CREDENTIALING
Credential:
Phone: 501-326-6757