=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467182683
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIMON-STUEART COUNSELING SERVICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2022
-----------------------------------------------------
Last Update Date | 10/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 MALVERN AVE
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71901-6327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-796-0623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 325 W OLIVE ST
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71857-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-796-0623
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | NICOLE SIMON
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 870-796-0623
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------