Healthcare Provider Details

I. General information

NPI: 1114693744
Provider Name (Legal Business Name): TCIY COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE 28TH ST STE 3
BENTONVILLE AR
72712-3206
US

IV. Provider business mailing address

1001 SE 28TH ST STE 3
BENTONVILLE AR
72712-3206
US

V. Phone/Fax

Practice location:
  • Phone: 479-295-3325
  • Fax: 888-630-4808
Mailing address:
  • Phone: 479-295-3325
  • Fax: 888-630-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CARLA J JONES
Title or Position: CLINICAL DIRECTOR
Credential: LPC, LMFT
Phone: 620-235-9768