Healthcare Provider Details

I. General information

NPI: 1962019604
Provider Name (Legal Business Name): THERAPY FRIENDS COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2020
Last Update Date: 09/27/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 OLD GREENWOOD RD STE 108
FORT SMITH AR
72903-6913
US

IV. Provider business mailing address

3201 S 97TH ST
FORT SMITH AR
72903-5709
US

V. Phone/Fax

Practice location:
  • Phone: 479-461-7767
  • Fax:
Mailing address:
  • Phone: 479-461-7677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LOUGIN
Title or Position: OWNER/ PROVIDER
Credential: LPC
Phone: 479-461-7767