Healthcare Provider Details

I. General information

NPI: 1558698704
Provider Name (Legal Business Name): ADVANCED COUNSELING AND NEUROFEEDBACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S MAIN ST
SEARCY AR
72143-7319
US

IV. Provider business mailing address

1120 S MAIN ST
SEARCY AR
72143-7319
US

V. Phone/Fax

Practice location:
  • Phone: 501-207-3469
  • Fax:
Mailing address:
  • Phone: 501-207-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0002003
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0007003
License Number StateAR

VIII. Authorized Official

Name: MS. FAYE M DORAN
Title or Position: PRESIDENT/OWNER
Credential: LPC LMFT EDD
Phone: 501-207-3469