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General NPI Number Information
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NPI Number | 1689116048
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Entity Type | Organization
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Legal Business Name | ELEMENTAL COUNSELING
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 1002 SE C ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-6327
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Country | US
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Telephone | 479-925-4444
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Fax | 479-544-9393
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Provider Business Mailing Address
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Address Line | 1002 SE C ST
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City | BENTONVILLE
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State | AR
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Zip | 72712-6327
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Country | US
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Telephone | 479-925-4444
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Fax | 479-544-9393
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Authorized Official
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Title or Position | OWNER
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Name | KHARMA PARKER
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Credential | LPC, LAMFT
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Telephone | 479-925-4444
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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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