MEDICARE: NEW CREATION PROFESSIONAL COUNSELING AND MANAGEMENT SERVICES, 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
1	101YM0800X	Mental Health Counselor	P0406024	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1922128370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW CREATION PROFESSIONAL COUNSELING AND MANAGEMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	800 S MOUNT OLIVE ST STE B
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4203
Country	:	US
Telephone Number	:	479-524-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 S MOUNT OLIVE ST STE B
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-4203
Country	:	US
Telephone Number	:	479-524-0477
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST/OWNER
Name	:	DEBBIE J. HARRIS
Credential	:	L.P.C.
Telephone Number	:	479-524-0477

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	06/15/2010

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