Healthcare Provider Details

I. General information

NPI: 1053874818
Provider Name (Legal Business Name): THE STORIE HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 ROGERS AVE STE D
FORT SMITH AR
72901-4268
US

IV. Provider business mailing address

2912 ROGERS AVE STE D
FORT SMITH AR
72901-4268
US

V. Phone/Fax

Practice location:
  • Phone: 479-242-3200
  • Fax: 479-242-3222
Mailing address:
  • Phone: 479-242-3200
  • Fax: 479-242-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN WADE STORIE
Title or Position: OWNER/DIRECTOR
Credential: LPC
Phone: 918-208-9555