Healthcare Provider Details

I. General information

NPI: 1215800255
Provider Name (Legal Business Name): 4 FLAMES COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 KERSEY RD STE 2
BRANCH AR
72928-7011
US

IV. Provider business mailing address

2411 KERSEY RD
BRANCH AR
72928-7011
US

V. Phone/Fax

Practice location:
  • Phone: 641-895-2971
  • Fax:
Mailing address:
  • Phone: 479-879-9413
  • Fax: 479-879-9415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JESSIE DARYN LASSABE
Title or Position: INCORPORATOR/ORGANIZER
Credential:
Phone: 641-895-2971