Healthcare Provider Details

I. General information

NPI: 1417109703
Provider Name (Legal Business Name): COUNSELING ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S SALEM RD
CONWAY AR
72034-8365
US

IV. Provider business mailing address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

V. Phone/Fax

Practice location:
  • Phone: 501-328-2242
  • Fax: 501-328-2244
Mailing address:
  • Phone: 479-967-5570
  • Fax: 479-890-5364

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

VIII. Authorized Official

Name: BRIAN LUTZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 479-967-5570