Healthcare Provider Details

I. General information

NPI: 1477079325
Provider Name (Legal Business Name): TRANSFORMING LIVES COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 TATE AVE
MAMMOTH SPRING AR
72554-8064
US

IV. Provider business mailing address

PO BOX 1134
MAMMOTH SPRING AR
72554-1134
US

V. Phone/Fax

Practice location:
  • Phone: 870-625-0273
  • Fax: 870-625-0275
Mailing address:
  • Phone: 870-625-0273
  • Fax: 870-625-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberP1069126
License Number StateAR

VIII. Authorized Official

Name: FRANCES M SMITH
Title or Position: PRESIDENT/THERAPIST
Credential: LPC
Phone: 870-625-0273