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General NPI Number Information
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NPI Number | 1467076448
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Entity Type | Organization
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Legal Business Name | LILLIES IN THE VALLEY COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 104 SONNET ST
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City | HOT SPRINGS
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State | AR
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Zip | 71913-4437
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Country | US
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Telephone | 501-553-5539
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1011
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City | HOT SPRINGS
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State | AR
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Zip | 71902-1011
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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 | MENTAL HEALTH THERAPIST
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Name | FANNIE BEATRICE WALLACE, MS
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Credential | LAC
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Telephone | 501-553-5538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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