Healthcare Provider Details

I. General information

NPI: 1801448840
Provider Name (Legal Business Name): JOSHUA MEDLEY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 11/21/2021
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S COLLEGE ST
MOUNTAIN HOME AR
72653-3925
US

IV. Provider business mailing address

510 S COLLEGE ST
MOUNTAIN HOME AR
72653-3925
US

V. Phone/Fax

Practice location:
  • Phone: 870-232-4273
  • Fax: 870-345-1310
Mailing address:
  • Phone: 870-232-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MEDLEY
Title or Position: THERAPIST/OWNER
Credential: ED.S., LPC
Phone: 504-559-3497