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General NPI Number Information
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NPI Number | 1356874945
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 713 FALLS BLVD N SUITE A
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City | WYNNE
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State | AR
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Zip | 72396-2208
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Country | US
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Telephone | 870-587-7056
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Fax |
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Provider Business Mailing Address
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Address Line | 422 COUNTY ROAD 225
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City | CHERRY VALLEY
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State | AR
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Zip | 72324-8760
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INCORPORATOR/ORGANIZER
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Name | MRS. MERIDETH L JOHNSON
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Credential | LCSW
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Telephone | 870-587-7056
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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 | 4510C
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License Number State | AR
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