Healthcare Provider Details

I. General information

NPI: 1073113650
Provider Name (Legal Business Name): SECURE FOUNDATION COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2020
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 E MATTHEWS AVE
JONESBORO AR
72401-3048
US

IV. Provider business mailing address

PO BOX 1541
JONESBORO AR
72403-1541
US

V. Phone/Fax

Practice location:
  • Phone: 870-218-1722
  • Fax: 501-712-3898
Mailing address:
  • Phone: 870-218-1722
  • Fax: 501-712-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MATTHEW LLOYD JR.
Title or Position: OWNER
Credential: LPC
Phone: 870-897-6688