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General NPI Number Information
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NPI Number | 1437164977
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING ASSOCIATES INC.
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 4354 STOCKTON DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2917
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Country | US
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Telephone | 501-955-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S 48TH ST
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City | SPRINGDALE
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State | AR
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Zip | 72762-6683
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Country | US
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Telephone | 479-725-2020
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SUPERVISOR
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Name | KELLY BUNCH
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Credential |
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Telephone | 797-255-1154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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