| Transforming Lives Counseling Llc | |
|
1355 Tate Ave Mammoth Spring AR 72554-8064 | |
| (870) 625-0273 | |
| (870) 625-0275 |
| Full Name | Transforming Lives Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1355 Tate Ave, Mammoth Spring, Arkansas |
| Authorized Official Name and Position | Frances M Smith (PRESIDENT/THERAPIST) |
| Authorized Official Contact | 8706250273 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transforming Lives Counseling Llc Po Box 1134 Mammoth Spring AR 72554-1134 Ph: (870) 625-0273 | Transforming Lives Counseling Llc 1355 Tate Ave Mammoth Spring AR 72554-8064 Ph: (870) 625-0273 |
| NPI Number | 1477079325 |
|---|---|
| Provider Enumeration Date | 08/22/2017 |
| Last Update Date | 09/28/2021 |
| Certification Date | 09/28/2021 |
| Medicare PECOS PAC ID | 4587090113 |
|---|---|
| Medicare Enrollment ID | O20200130000931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477079325 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | P1069126 (Arkansas) | Primary |
| Provider Name | Hazel E Wilcox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255764312 PECOS PAC ID: 6204262066 Enrollment ID: I20200214001228 |
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