Healthcare Provider Details

I. General information

NPI: 1922693290
Provider Name (Legal Business Name): MOTIVATIONAL INSPIRATIONAL TRANSFORMING COUNSELING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 FORD LANE
MARION AR
72364
US

IV. Provider business mailing address

603 FORD LANE
MARION AR
72364
US

V. Phone/Fax

Practice location:
  • Phone: 870-623-9162
  • Fax:
Mailing address:
  • Phone: 870-623-9162
  • Fax:

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 State

VIII. Authorized Official

Name: MR. PAUL BAILEY III
Title or Position: THERAPIST
Credential: LPC
Phone: 870-623-9162