Healthcare Provider Details

I. General information

NPI: 1912753328
Provider Name (Legal Business Name): TENACIOUS HEALING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 CENTER ST STE 1420
LITTLE ROCK AR
72201-2651
US

IV. Provider business mailing address

323 CENTER ST STE 1420
LITTLE ROCK AR
72201-2651
US

V. Phone/Fax

Practice location:
  • Phone: 501-474-6131
  • Fax: 501-298-2684
Mailing address:
  • Phone: 501-474-6131
  • Fax: 501-298-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANICE COBURN
Title or Position: CLINICAL MANAGER/OWNER
Credential: LCSW
Phone: 501-358-9625