Healthcare Provider Details

I. General information

NPI: 1508641259
Provider Name (Legal Business Name): CACHE RIVER COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N EDMONDS AVE
MC CRORY AR
72101-8000
US

IV. Provider business mailing address

202 N EDMONDS AVE
MC CRORY AR
72101-8000
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-0345
  • Fax: 870-731-0345
Mailing address:
  • Phone: 870-919-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CANDIE M DEPRIEST
Title or Position: OWNER
Credential: QBHP
Phone: 870-731-0345