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General NPI Number Information
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NPI Number | 1912941220
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Entity Type | Organization
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Legal Business Name | FORDYCE COUNSELING CLINIC, INC.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1101 W 3RD ST
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City | FORDYCE
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State | AR
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Zip | 71742-3014
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Country | US
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Telephone | 870-352-5122
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Fax | 870-352-5127
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Provider Business Mailing Address
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Address Line | 1101 W 3RD ST
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City | FORDYCE
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State | AR
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Zip | 71742-3014
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Country | US
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Telephone | 870-352-5122
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Fax | 870-352-5127
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DANIEL LOYD MOORE
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Credential | M.S., L.A.C.
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Telephone | 870-352-5122
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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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