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General NPI Number Information
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NPI Number | 1023583671
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Entity Type | Organization
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Legal Business Name | NEWLEAF COUNSELING OF THE RIVER VALLEY
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 16135 HIGHWAY 71 S
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City | GREENWOOD
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State | AR
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Zip | 72936-7218
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Country | US
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Telephone | 479-996-5433
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Fax | 479-996-0438
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Provider Business Mailing Address
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Address Line | 4108 HARDIE AVE
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City | FORT SMITH
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State | AR
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Zip | 72903-1143
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Country | US
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Telephone | 479-228-2094
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | BRYANT O PRIETO
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Credential | LPC
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Telephone | 479-228-2094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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