Provider Demographics
NPI:1558017798
Name:PSYCHOTHERAPY - BEHAVIORAL & MENTAL HEALTH COUNSELING/LLC
Entity Type:Organization
Organization Name:PSYCHOTHERAPY - BEHAVIORAL & MENTAL HEALTH COUNSELING/LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICELM-LEI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLERE
Authorized Official - Suffix:I
Authorized Official - Credentials:PSYCHIATRY CLINICIAN
Authorized Official - Phone:270-312-4085
Mailing Address - Street 1:132 N FOURTH
Mailing Address - Street 2:
Mailing Address - City:WEST HELENA
Mailing Address - State:AR
Mailing Address - Zip Code:72390-2430
Mailing Address - Country:US
Mailing Address - Phone:270-801-3436
Mailing Address - Fax:
Practice Address - Street 1:112 GARLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST HELENA
Practice Address - State:AR
Practice Address - Zip Code:72390-2440
Practice Address - Country:US
Practice Address - Phone:870-714-5874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR MAURICELMLEI MILLERE, DD BMH CPC CC, COUNSELING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1922754118Medicaid