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General NPI Number Information
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NPI Number | 1053874818
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Entity Type | Organization
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Legal Business Name | THE STORIE HOUSE LLC
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 4019 MASSARD RD
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City | FORT SMITH
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State | AR
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Zip | 72903-6221
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Country | US
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Telephone | 918-208-9555
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Fax | 479-646-7977
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Provider Business Mailing Address
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Address Line | 4019 MASSARD RD
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City | FORT SMITH
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State | AR
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Zip | 72903-6221
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Country | US
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Telephone | 918-208-9555
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Fax | 479-646-7977
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. BENJAMIN WADE STORIE
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Credential | LPC
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Telephone | 918-208-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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