Healthcare Provider Details

I. General information

NPI: 1073102620
Provider Name (Legal Business Name): PROSPERING HOPE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SCHOOL DR STE B
MELBOURNE AR
72556-8620
US

IV. Provider business mailing address

PO BOX 245
MELBOURNE AR
72556-0245
US

V. Phone/Fax

Practice location:
  • Phone: 870-300-2112
  • Fax: 844-377-1447
Mailing address:
  • Phone: 870-300-2112
  • Fax: 844-377-1447

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: DANA INGRAM
Title or Position: PRESIDENT
Credential: LPC, NCC
Phone: 870-300-2112