Provider Demographics
NPI:1477051654
Name:LIFE WITHIN COUNSELING GROUP, LLC
Entity Type:Organization
Organization Name:LIFE WITHIN COUNSELING GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-712-3031
Mailing Address - Street 1:905 MCAFEE MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012
Mailing Address - Country:US
Mailing Address - Phone:501-712-3031
Mailing Address - Fax:501-242-0820
Practice Address - Street 1:905 MCAFEE MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012
Practice Address - Country:US
Practice Address - Phone:501-712-3031
Practice Address - Fax:501-242-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1412126101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183080795Medicaid