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General NPI Number Information
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NPI Number | 1245961986
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Entity Type | Organization
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Legal Business Name | STABLE MINDED, LLC
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Dates
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Enumeration Date | 06/22/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 4415 N 2ND ST
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City | ROGERS
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State | AR
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Zip | 72756-7413
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Country | US
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Telephone | 479-397-1807
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Fax |
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Provider Business Mailing Address
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Address Line | 8812 OLD DUTCH ELBOW
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City | ROGERS
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State | AR
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Zip | 72756-7862
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Country | US
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Telephone | 954-817-3404
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MANAGER
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Name | KELLY KING
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Credential |
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Telephone | 479-366-4241
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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 |
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License Number State |
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Taxonomy #2
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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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