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General NPI Number Information
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NPI Number | 1790082311
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL COUNSELING SERVICES OF MAGNOLIA
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 03/21/2011
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Provider Practice Location Address
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Address Line | 1327 N WASHINGTON
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City | MAGNOLIA
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State | AR
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Zip | 71753-2067
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Country | US
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Telephone | 870-235-1112
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Fax | 870-235-1114
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Provider Business Mailing Address
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Address Line | 1327 N WASHINGTON
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City | MAGNOLIA
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State | AR
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Zip | 71753-2067
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Country | US
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Telephone | 870-235-1112
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Fax | 870-235-1114
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. MARIAN F GREEN
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Credential | LPC
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Telephone | 870-235-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 218949578
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License Number State | AR
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