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General NPI Number Information
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NPI Number | 1568353597
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Entity Type | Organization
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Legal Business Name | SPA CITY COUNSELING AND WELLNESS INC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 135 SAWTOOTH OAK ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7160
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Country | US
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Telephone | 501-781-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 135 SAWTOOTH OAK ST
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City | HOT SPRINGS
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State | AR
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Zip | 71901-7160
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Country | US
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Telephone | 870-210-0230
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY NICOLE MALCOM-BUTLER
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Credential | APRN, PMHNP-BC
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Telephone | 870-210-0230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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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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