MEDICARE: JKL COUNSELING & CONSULTING, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1952120552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JKL COUNSELING & CONSULTING, PLLC

Provider Business Mailing Address
First Line	:	2863 N OLD MISSOURI RD STE 108D
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3777
Country	:	US
Telephone Number	:	479-348-2397
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 N OLD MISSOURI RD STE 108D
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703-3777
Country	:	US
Telephone Number	:	479-348-2397
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JENNI LONG
Credential	:
Telephone Number	:	479-348-2397

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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