Healthcare Provider Details

I. General information

NPI: 1619871233
Provider Name (Legal Business Name): LIFTED COUNSELING & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S MAIN ST STE B
BERRYVILLE AR
72616-3931
US

IV. Provider business mailing address

310 S MAIN ST STE B
BERRYVILLE AR
72616-3931
US

V. Phone/Fax

Practice location:
  • Phone: 870-955-4054
  • Fax: 479-397-3311
Mailing address:
  • Phone: 870-955-4054
  • Fax: 479-397-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CRYSTAL LYLE
Title or Position: LPC
Credential: LPC
Phone: 870-955-4054