=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942969076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW PARADIGM COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2021
-----------------------------------------------------
Last Update Date | 12/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 E MEADOW ST STE 8
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72701-5357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-332-4112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 E MEADOW ST STE 8
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72701-5357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-332-4112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | ANALISA CHAVEZ
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 479-332-4112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------