Provider Demographics
NPI:1578336509
Name:SIMPLE SOUL COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:SIMPLE SOUL COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ACACIA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS LPC
Authorized Official - Phone:870-204-5640
Mailing Address - Street 1:303 W NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-5839
Mailing Address - Country:US
Mailing Address - Phone:870-204-5640
Mailing Address - Fax:870-204-5306
Practice Address - Street 1:351 E PRIDDY ST STE B
Practice Address - Street 2:
Practice Address - City:MAGAZINE
Practice Address - State:AR
Practice Address - Zip Code:72943-8503
Practice Address - Country:US
Practice Address - Phone:870-204-5640
Practice Address - Fax:870-204-5306
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLE SOUL COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)