Healthcare Provider Details

I. General information

NPI: 1770361339
Provider Name (Legal Business Name): COUNSELING CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SUPERIOR ST
HOT SPRINGS AR
71901-2630
US

IV. Provider business mailing address

110 PEARSON
BENTON AR
72015-4436
US

V. Phone/Fax

Practice location:
  • Phone: 501-623-3477
  • Fax: 501-624-7498
Mailing address:
  • Phone: 501-315-4224
  • Fax: 501-778-0450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BENNETT
Title or Position: CEO
Credential: LCSW
Phone: 501-315-4224