Healthcare Provider Details

I. General information

NPI: 1588357768
Provider Name (Legal Business Name): REFRAME FAMILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SHADY LN
MALVERN AR
72104-6041
US

IV. Provider business mailing address

1910 SHADY LN
MALVERN AR
72104-6041
US

V. Phone/Fax

Practice location:
  • Phone: 501-802-0107
  • Fax:
Mailing address:
  • Phone: 501-802-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY ELIZABETH BACON-LATINA
Title or Position: THERAPIST; OWNER
Credential: LPC, LMFT
Phone: 501-802-0107