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General NPI Number Information
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NPI Number | 1114693744
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Entity Type | Organization
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Legal Business Name | TCIY COUNSELING, INC.
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 1001 SE 28TH ST STE 3
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City | BENTONVILLE
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State | AR
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Zip | 72712-3206
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Country | US
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Telephone | 479-295-3325
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Fax | 888-630-4808
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Provider Business Mailing Address
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Address Line | 1001 SE 28TH ST STE 3
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City | BENTONVILLE
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State | AR
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Zip | 72712-3206
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Country | US
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Telephone | 479-295-3325
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Fax | 888-630-4808
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | CARLA J JONES
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Credential | LPC, LMFT
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Telephone | 620-235-9768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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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