Healthcare Provider Details

I. General information

NPI: 1912757147
Provider Name (Legal Business Name): VAN BUREN COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MAIN ST
VAN BUREN AR
72956-4731
US

IV. Provider business mailing address

1500 MAIN ST
VAN BUREN AR
72956-4731
US

V. Phone/Fax

Practice location:
  • Phone: 479-689-9335
  • Fax:
Mailing address:
  • Phone: 479-689-9335
  • Fax:

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: HALEY BRYANT
Title or Position: OWNER
Credential: LPC, LMFT
Phone: 479-689-9335