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General NPI Number Information
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NPI Number | 1821515909
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Entity Type | Organization
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Legal Business Name | NEW GENESIS COUNSELING
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 10/16/2017
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Provider Practice Location Address
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Address Line | 2031 N GREEN ACRES RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-2619
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Country | US
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Telephone | 720-217-7596
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Fax |
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Provider Business Mailing Address
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Address Line | 14642 S HIGHWAY 170
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City | WEST FORK
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State | AR
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Zip | 72774-9224
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | MR. ROBERT LEE WALTON III
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Credential | LPC
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Telephone | 720-217-7596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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