Provider Demographics
NPI:1164863981
Name:WATERSTONE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:WATERSTONE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:BLAKELY
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:479-202-6300
Mailing Address - Street 1:1672 SOUTH 48TH STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5880
Mailing Address - Country:US
Mailing Address - Phone:479-202-6300
Mailing Address - Fax:479-202-6300
Practice Address - Street 1:1672 SOUTH 48TH STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5880
Practice Address - Country:US
Practice Address - Phone:479-202-6300
Practice Address - Fax:479-202-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1209072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty