Healthcare Provider Details

I. General information

NPI: 1326040692
Provider Name (Legal Business Name): WESTERN ARKANSAS COUNSELING & GUIDANCE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 S 70TH ST
FORT SMITH AR
72903-5017
US

IV. Provider business mailing address

PO BOX 11818
FORT SMITH AR
72917-1818
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-6650
  • Fax: 479-452-5847
Mailing address:
  • Phone: 479-452-6650
  • Fax: 479-452-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateAR

VIII. Authorized Official

Name: MRS. AARON R HOLWICK
Title or Position: CEO
Credential: LPE-I
Phone: 479-452-6650