Healthcare Provider Details

I. General information

NPI: 1699682062
Provider Name (Legal Business Name): ARK VALLEY COUNSELING & SUPERVISION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24600 COUNTY ROAD 21
LA JUNTA CO
81050-9765
US

IV. Provider business mailing address

24600 COUNTY ROAD 21
LA JUNTA CO
81050-9765
US

V. Phone/Fax

Practice location:
  • Phone: 719-469-2670
  • Fax: 719-928-4181
Mailing address:
  • Phone: 719-469-2670
  • Fax: 719-928-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAYLAND L SMITH
Title or Position: OWNER
Credential:
Phone: 719-469-2670