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General NPI Number Information
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NPI Number | 1427864495
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGY AND COUNSELING
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 118 E SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2830
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Country | US
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Telephone | 479-444-1400
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Fax | 479-444-1422
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Provider Business Mailing Address
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Address Line | 118 E SUNBRIDGE DR
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2830
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Country | US
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Telephone | 479-444-1400
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Fax | 479-444-1422
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Authorized Official
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Title or Position | ASSISTANT MANAGER
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Name | JENNIFER CREEL
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Credential |
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Telephone | 479-444-1400
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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