Provider Demographics
NPI:1073113650
Name:SECURE FOUNDATION COUNSELING PLLC
Entity Type:Organization
Organization Name:SECURE FOUNDATION COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-897-6688
Mailing Address - Street 1:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1541
Mailing Address - Country:US
Mailing Address - Phone:870-897-6688
Mailing Address - Fax:
Practice Address - Street 1:125 N FISHER ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-2116
Practice Address - Country:US
Practice Address - Phone:870-897-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-31
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)