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General NPI Number Information
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NPI Number | 1902792641
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Entity Type | Organization
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Legal Business Name | RESILIENT YOUTH COUNSELING LLC
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2408 S 51ST CT STE G
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City | FORT SMITH
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State | AR
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Zip | 72903-3666
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Country | US
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Telephone | 479-323-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 S 99TH ST
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City | FORT SMITH
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State | AR
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Zip | 72903-5346
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Country | US
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Telephone | 501-908-5187
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Fax |
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Authorized Official
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Title or Position | LAC
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Name | AVANLEA CHANEY
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Credential | MS
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Telephone | 501-908-5187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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