Healthcare Provider Details

I. General information

NPI: 1013498542
Provider Name (Legal Business Name): COUNSELING ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MOUNTAIN PLACE DRIVE
MOUNTAIN VIEW AR
72560
US

IV. Provider business mailing address

110 SKYLINE DR
RUSSELLVILLE AR
72801-3362
US

V. Phone/Fax

Practice location:
  • Phone: 870-269-4193
  • Fax: 479-890-5364
Mailing address:
  • Phone: 479-968-1298
  • Fax: 479-968-6053

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: BRIAN LUTZ
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 479-967-5570