Healthcare Provider Details

I. General information

NPI: 1740107481
Provider Name (Legal Business Name): TEEN FOCUSED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 S 54TH ST STE 5
ROGERS AR
72758-8169
US

IV. Provider business mailing address

980 REDFREE DR
BENTONVILLE AR
72712-3099
US

V. Phone/Fax

Practice location:
  • Phone: 479-357-2661
  • Fax:
Mailing address:
  • Phone: 479-357-2661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSE KOSKOVICK
Title or Position: COUNSELOR
Credential: LPC
Phone: 402-210-8224