Healthcare Provider Details

I. General information

NPI: 1346904331
Provider Name (Legal Business Name): SHILOH'S COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 CENTRAL AVE STE A
HOT SPRINGS AR
71913-6472
US

IV. Provider business mailing address

3634 CENTRAL AVE STE A
HOT SPRINGS AR
71913-6472
US

V. Phone/Fax

Practice location:
  • Phone: 501-547-3763
  • Fax:
Mailing address:
  • Phone: 501-547-3763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JASON WALLER
Title or Position: MANAGER
Credential: LPC
Phone: 501-547-3763