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General NPI Number Information
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NPI Number | 1619871233
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Entity Type | Organization
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Legal Business Name | LIFTED COUNSELING & WELLNESS, PLLC
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 310 S MAIN ST STE B
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City | BERRYVILLE
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State | AR
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Zip | 72616-3931
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Country | US
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Telephone | 870-955-4054
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Fax | 479-397-3311
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Provider Business Mailing Address
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Address Line | 310 S MAIN ST STE B
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City | BERRYVILLE
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State | AR
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Zip | 72616-3931
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Country | US
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Telephone | 870-955-4054
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Fax | 479-397-3311
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Authorized Official
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Title or Position | LPC
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Name | CRYSTAL LYLE
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Credential | LPC
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Telephone | 870-955-4054
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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 | NULL
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