Provider Demographics
NPI:1508641259
Name:CACHE RIVER COUNSELING, LLC
Entity Type:Organization
Organization Name:CACHE RIVER COUNSELING, LLC
Other - Org Name:CACHE RIVER COUNCELING LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CANDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:QBHP
Authorized Official - Phone:870-731-0345
Mailing Address - Street 1:202 N EDMONDS AVE
Mailing Address - Street 2:
Mailing Address - City:MC CRORY
Mailing Address - State:AR
Mailing Address - Zip Code:72101-8000
Mailing Address - Country:US
Mailing Address - Phone:870-919-4501
Mailing Address - Fax:
Practice Address - Street 1:202 N EDMONDS AVE
Practice Address - Street 2:
Practice Address - City:MC CRORY
Practice Address - State:AR
Practice Address - Zip Code:72101-8000
Practice Address - Country:US
Practice Address - Phone:870-731-0345
Practice Address - Fax:870-731-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health