Healthcare Provider Details

I. General information

NPI: 1225585201
Provider Name (Legal Business Name): HENRY COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NORTH MAIN ST.
GREENWOOD AR
72936
US

IV. Provider business mailing address

1611 JACKSON ST
FORT SMITH AR
72901-7249
US

V. Phone/Fax

Practice location:
  • Phone: 479-420-0330
  • Fax:
Mailing address:
  • Phone: 479-420-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP1312115
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM1312014
License Number StateAR

VIII. Authorized Official

Name: MS. JENNIFER MICHELLE HENRY
Title or Position: THERAPIST
Credential: LPC, LMFT
Phone: 479-420-0330