Provider Demographics
NPI:1568913499
Name:ADAM MAISEN COUNSELING, LLC
Entity Type:Organization
Organization Name:ADAM MAISEN COUNSELING, LLC
Other - Org Name:REFUGE COUNSELING OF ARKANSAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MAISEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:870-293-2054
Mailing Address - Street 1:812 CLINTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5924
Mailing Address - Country:US
Mailing Address - Phone:870-293-2054
Mailing Address - Fax:870-464-1073
Practice Address - Street 1:812 CLINTON ST STE B
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5924
Practice Address - Country:US
Practice Address - Phone:870-293-2054
Practice Address - Fax:870-464-1073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1010071305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1144417171Medicaid