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NPI Code Detail

MEDICARE: COUNSELING CLINIC, INC

MEDICARE: COUNSELING CLINIC, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
22084P0800XPsychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649267659
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNSELING CLINIC, INC
Provider Business Mailing Address
First Line : 110 PEARSON
Second Line :
City : BENTON
State : AR
Zip : 72015-4436
Country : US
Telephone Number : 501-315-4224
Fax Number : 501-778-0450
Provider Business Practice Location Address
First Line : 110 PEARSON
Second Line :
City : BENTON
State : AR
Zip : 72015-4436
Country : US
Telephone Number : 501-315-4224
Fax Number : 501-778-0450
Authorized Official
Title or Position : CEO
Name : ROBERT BENNETT
Credential : LCSW
Telephone Number : 501-315-4224
Provider Enumeration Date : 10/04/2005
Last Update Date : 08/30/2023

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Directions to “COUNSELING CLINIC, INC ” Practice Location

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