Healthcare Provider Details

I. General information

NPI: 1417865346
Provider Name (Legal Business Name): WISE COUNSEL MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 OAK ST
CONWAY AR
72032-4318
US

IV. Provider business mailing address

1716 S GRANT ST
LITTLE ROCK AR
72204-3674
US

V. Phone/Fax

Practice location:
  • Phone: 682-455-5007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CANAA L LEE
Title or Position: OWNER
Credential:
Phone: 682-465-5007