Provider Demographics
NPI:1043856172
Name:MENTAL HEALTH COUNSELING FOR INDIVIDUALS AND COUPLES
Entity type:Organization
Organization Name:MENTAL HEALTH COUNSELING FOR INDIVIDUALS AND COUPLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-639-3907
Mailing Address - Street 1:PO BOX 10563
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0003
Mailing Address - Country:US
Mailing Address - Phone:870-639-3907
Mailing Address - Fax:866-644-2617
Practice Address - Street 1:3256 WEST HILLSBORO SUITE C
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-639-3907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)