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General NPI Number Information
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NPI Number | 1205382793
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Entity Type | Organization
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Legal Business Name | MOMENTUM COUNSELING, PLLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 593 S HORSEBARN RD STE 102
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City | ROGERS
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State | AR
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Zip | 72758-8797
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Country | US
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Telephone | 479-657-6636
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Fax | 479-657-6618
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Provider Business Mailing Address
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Address Line | 13449 SAINT ANDREWS DR
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761-9610
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Country | US
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Telephone | 479-524-7742
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RUTH M ABBEY
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Credential | LPC
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Telephone | 479-524-7742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1302005
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License Number State | AR
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